尿毒症不宁腿岛叶功能连接异常的静息态功能磁共振研究  

Abnormality of insular functional connectivity in uremic restless legs: A resting state functional magnetic resonance study

作　　者：丁墩 马雪英[2] 李朋[2] 张盼[1,2] 麻少辉[2] 吕晶[3] 刘继欣[4] 张明 DING Dun;MA Xueying;LI Peng;ZHANG Pan;MA Shaohui;L Jing;LIU Jixin;ZHANG Ming(Department of Diagnostic Radiology,The Second Affiliated Hospital of Xi'an Jiaotong University,Xi'an 710004;Department of Radiology,The First Affiliated Hospital of Xi'an Jiaotong University,Xi'an 710061;Department of Nephrology,The First Affiliated Hospital of Xi'an Jiaotong University,Xi'an 710061;School of Life Science and Technology,Xidian University,Xi'an 710071,China)

机构地区：[1]西安交通大学第二附属医院影像科,陕西西安710004 [2]西安交通大学第一附属医院医学影像科,陕西西安710061 [3]西安交通大学第一附属医院肾内科,陕西西安710061 [4]西安电子科技大学生命科学技术学院,陕西西安710071

出　　处：《西安交通大学学报（医学版）》2020年第2期172-176,共5页Journal of Xi’an Jiaotong University（Medical Sciences）

基　　金：陕西省自然科学基础研究计划重大基础研究项目(No.S2017-ZRJJ-ZDXM-0058);西安交通大学第一附属医院临床研究课题重点项目(No.XJTU1AF-CRF-2018-006);西安交通大学第二附属医院院基金青年项目[No.YJ(QN)201801]~~

摘　　要：目的采用基于种子点的静息态功能连接分析方法研究尿毒症不宁腿(uremic restless legs syndrome,uRLS)患者的岛叶功能连接改变,探寻不宁腿症状的相关危险因素。方法对29例维持性血液透析的uRLS患者(uRLS组)和29例健康志愿者(对照组)进行高分辨3DT1结构成像,利用基于体素的形态学测量(VBM)方法分析两组前后岛叶灰质体积差异,选取有差异的区域进行静息态功能连接分析并组间比较,随后通过Pearson相关分析寻找与RLS严重程度评分显著相关的功能连接特征,进一步利用Pearson相关分析方法探寻与RLS评分相关的临床血清学检测指标,并与岛叶功能连接特征进行相关分析。结果与对照组比较,uRLS组灰质体积减小的区域位于左侧后岛叶(P<0.05,FWE校正),根据基于VBM结果的ROI分析,以左侧后岛叶作为种子点的功能连接分析结果显示其主要与双侧初级感觉运动区(primary sensorimotor cortex,S1)、双侧辅助运动区(supplementary motor areas,SMA)及中扣带后部(posterior mid-cingulate cortex,pMCC)功能连接度减低。患者组RLS严重程度评分与左侧后岛叶功能连接度呈负相关的区域主要位于双侧S1;逐步回归分析显示RLS严重程度评分仅与血红蛋白浓度呈负相关(r=-0.449,P=0.015),uRLS组血红蛋白浓度与左侧后岛叶-左侧S1功能连接度呈显著正相关。结论uRLS患者存在后岛叶的形态学改变,岛叶-S1功能连接度减低与患者RLS症状严重程度有关,低水平血红蛋白可能是uRLS患者大脑功能连接特征异常密切相关的临床危险因素。Objective To investigate the changes of insular functional connectivity in patients with uremic restless legs syndrome(uRLS)using seed-based resting-state functional connectivity analysis so as to explore the related risk factors for RLS.Methods 3D high-resolution structural imaging was applied in 29 patients with uremic restless legs(uRLS group)and 29 healthy volunteers(control group)with maintenance hemodialysis.The grey matter volume of the insular cortex was assessed using a voxel-based morphometry(VBM)analysis and functional connectivity of insular variation was evaluated by a seed-based correlation analysis,while the seed was chosen as the significant difference of grey matter volume.Pearson correlation analysis was used to explore the significant correlation between functional connectivity and RLS score.The relationship between brain alterations and clinical variables were investigated with Logistic stepwise multiple regression analysis.Results Compared with that in the control group,the area with reduced gray matter volume in the uRLS group was located on the left posterior insula(P<0.05,FWE correction).Taking the left post insular as a seed region,we further found reduced functional connectivity in patients mainly between the insular and primary sensorimotor cortex(S1),supplementary motor areas(SMA),and posterior mid-cingulate gyrus(P<0.05,FDR corrected).In uRLS group,the severity score of RLS was negatively correlated with insular-S1 functional connectivity(P<0.05,FDR corrected),while the hemoglobin level was negetively correlated with functional connectivity degree of insular-S1(r=-0.449,P=0.015,FDR corrected).Conclusion The altered morphology of the post insular cortex was revealed in uRLS patients.Abnormal sensorimotor activities in patients with RLS were closely associated with reduced functional connectivity of insular-S1.Low hemoglobin level was the most important risk factor for the abnormal functional connectivity of the brain.

关 键 词：尿毒症不宁腿 功能连接 灰质体积 静息态磁共振 感觉运动 

分 类 号：R445.2[医药卫生—影像医学与核医学]