慢性肾脏病3~4期患者认知功能损害的脑静息态功能磁共振研究  

Resting state functional magnetic resonance imaging and cognitive impairment in patients with stage 3-4 chronic kidney disease

作　　者：滕福斌[1] 石安琪 齐晓环 张婧倩[3] 段莹 王军[2] 王子辰[2] TENG Fu-Bin;SHI An-Qi;QI Xiao-Huan;ZHANG Jing-Qian;DUAN Ying;WANG Jun;WANG Zi-Chen(Department of Nephrology,Dongzhimen Hospital,Beijing University of Traditional Chinese Medicine,Beijing 100700,China;Department of Acupuncture and Moxibustion,Dongzhimen Hospital,Beijing University of Traditional Chinese Medicine,Beijing 100700,China;Department of Cardiology,Oriental Hospital,Beijing University of Traditional Chinese Medicine,Beijing 100078,China;Sleep Medicine Center,Air Force Characteristic Medical Center of PLA,Beijing 100142,China)

机构地区：[1]北京中医药大学东直门医院肾内科,北京100700 [2]北京中医药大学东直门医院针灸科,北京100700 [3]北京中医药大学东方医院心内科,北京100078 [4]解放军空军特色医学中心睡眠医学中心,北京100142

出　　处：《中华老年多器官疾病杂志》2020年第11期833-838,共6页Chinese Journal of Multiple Organ Diseases in the Elderly

基　　金：北京中医药大学青年教师项目(2018-JYB-JS084,2020-JYB-XJSJJ-046)。

摘　　要：目的观察慢性肾脏病(CKD)患者认知功能水平与脑功能的改变。方法选择2018年1月至2020年1月在东直门医院被诊断为CKD 3~4期的10例患者为观察组,同时纳入19例肾功能正常的受试者作为对照组。分别进行简明精神状态量表(MMSE)、听觉词语学习测验量表(AVLT)、数字广度(DST)、动物词语流畅性量表(AFT)、形状连线测试A和B(TMT A and B)和高山量表评价2组受试者的认知功能和对记忆的满意程度,并进行静息态功能磁共振扫描观察2组受试者脑功能的差异。临床数据采用SPSS 20.0统计软件处理。结果在认知功能方面,与对照组相比,观察组AVLT的即刻回忆、短延时回忆和长延时回忆得分均显著下降(P<0.005),高山量表评分显著降低(P=0.024)。在脑功能方面,观察组左侧海马度中心度值(DC)较对照组显著增加(P<0.01);左侧海马与额中回和中央前回的功能连接减弱(P<0.01),并且这种功能连接减弱与听觉短延时回忆和长延时回忆呈显著负相关(P<0.05)。结论CKD患者较肾功能正常的受试者认知功能水平有所下降,尤其是情景记忆功能;在脑功能方面,CKD患者的海马DC值增加,海马与额中回和中央前回的功能连接减弱,且这种功能连接减弱与情景记忆功能呈显著负相关。Objective To observe the changes of cognitive function and brain function in patients with chronic kidney disease(CKD).Methods Ten CKD patients with stage 3-4 diagnosed in Dongzhimen Hospital from January 2018 to January 2020 were selected as the observation group,and 19 subjects with normal renal function as the control group.The mini-mental state examination(MMSE)scale,auditory verbal learning test(AVLT)scale,digit span test(DST),animal fluency test(AFT)scale,trail making test part A and B(TMT A and B),and Alpine scale were used to evaluate the cognitive function and memory satisfaction of the two groups,and the resting-state functional MRI(rs-fMRI)scanning was performed to observe the differences in brain function between two groups.The clinical data were analyzed using SPSS statistics 20.0.Results In terms of cognitive function,compared with the control group,the scores of immediate recall,short-term recall and long-term recall of AVLT in the observation group were significantly decreased(P<0.005),and the score of Alpine scale was also significantly decreased(P=0.024).In terms of brain function,the left hippocampal degree centrality(DC)of the observation group was significantly higher than that of the control group(P<0.01);the functional connection between the left hippocampus and the middle frontal gyrus and precentral gyrus were decreased(P<0.01),and the weakened functional connection was significantly negatively correlated with auditory short-term recall and long-term recall(P<0.05).Conclusion Compared with people with normal renal function,CKD patients have a lower cognitive function,especially episodic memory function;in terms of brain function,CKD patients have higher DC of left hippocampus and lower functional connection between hippocampus and middle frontal gyrus and precentral gyrus,and this weakened functional connection is significantly negatively correlated with episodic memory function.

关 键 词：慢性肾脏病 认知功能 静息态磁共振 功能连接 

分 类 号：R692[医药卫生—泌尿科学]