基于三种不同静息态功能磁共振低频振幅算法研究终末期肾病维持性血液透析患者自发性脑活动的变化  

Study on the changes of spontaneous brain activity in maintenance hemodialysis patients with end-stage renal disease based on three different resting state-functional magnetic resonance low-frequency amplitude algorithms

作　　者：马驰 高耸[1] 李伟[1] 于澜[1] 付圣莉 任延德[1] Ma Chi;Gao Song;Li Wei;Yu Lan;Fu Shengli;Ren Yande(Department of Radiology,the Affiliated Hospital of Qingdao University,Qingdao,266555,China)

机构地区：[1]青岛大学附属医院放射科,青岛266555

出　　处：《中华医学杂志》2021年第4期265-270,共6页National Medical Journal of China

摘　　要：目的结合低频振幅(ALFF)、比率低频振幅(fALFF)和百分比振幅(PerAF)三种不同静息态功能磁共振低频振幅算法研究终末期肾病患者自发性脑活动的变化,并分析自发性脑活动变化与临床变量之间的关系。方法回顾性收集2018年8月至2019年12月青岛大学附属医院肾内科及肾移植科31例维持性血液透析治疗的终末期肾病(ESRD)患者以及37名健康志愿者的资料。所有受试者均进行了静息状态功能磁共振成像(rs-fMRI)扫描。分别计算各组受试者全脑ALFF、fALFF、PerAF值。组间比较采用独立样本t检验,并使用Pearson相关分析探讨显著差异脑区自发性脑活动变化与临床变量之间的相关性。结果与健康对照组相比,ESRD患者右侧舌回、双侧楔前叶、左侧额下回、右侧中扣带回平均ALFF(mALFF)值减低[错误发现率(FDR)校正,均P<0.01];双侧楔前叶、双侧后扣带回皮质、右侧距状裂周围皮质、双侧顶下小叶/颞顶交界区(包括双侧角回、颞中回、左侧缘上回)及双侧额下回平均PerAF(mPerAF)值减低(FDR校正,均P<0.01);两组间平均fALFF(mfALFF)值差异无统计学意义。相关性分析显示ESRD患者右侧角回(r=-0.509,P=0.003)、左侧缘上回(r=-0.405,P=0.024)mPerAF值与血清钾离子浓度呈负相关。双侧楔前叶mALFF值(r=0.058,P=0.004)、左侧角回mPerAF值(r=0.415,P=0.020)与血红蛋白水平呈正相关。结论ESRD患者存在多个脑区自发性脑活动降低,主要位于默认模式网络(DMN)区域,可能是其脑损伤潜在的病理生理学机制;控制血钾及血红蛋白水平对预防ESRD患者脑损伤的进展至关重要。Objective To investigate the changes of spontaneous brain activity in patients with end-stage renal disease(ESRD)by combining three different resting state functional magnetic resonance low frequency amplitude algorithms,including amplitude of low-frequency fluctuations(ALFF),fractional amplitude of low-frequency fluctuations(fALFF),and percent amplitude of fluctuation(PerAF),and to analyze the associations between spontaneous brain activity changes and clinical variables.Methods The data of 31 ESRD patients treated with maintenance hemodialysis and 37 healthy volunteers in the Department of Nephrology and Renal Transplantation of the Affiliated Hospital of Qingdao University from August 2018 to December 2019 were retrospectively collected.The resting state functional magnetic resonance imaging(rs-fMRI)scan was performed to calculate the ALFF,fALFF,and PerAF values of the whole brain of the subjects in each group.Independent sample t test was used for comparison between groups,and Pearson correlation analysis was used to investigate the correlation between spontaneous brain activity changes in brain regions with significant differences and clinical variables.Results Compared to healthy volunteers,patients with ESRD had decreased mean ALFF(mALFF)values of the right lingual gyrus,bilateral anterior precuneus,left inferior frontal gyrus,and right middle cingulate gyrus(FDR(false discovery rate)correction,all P<0.01);and decreased mean PerAF(mPerAF)values of the bilateral anterior precuneus,bilateral posterior cingulate cortex,right calcarine fissure and surrounding cortex,bilateral inferior parietal lobule/temporoparietal junction(including bilateral angular gyrus,middle temporal gyrus,left supramarginal gyrus),and bilateral inferior frontal gyrus(FDR(false discovery rate)correction,all P<0.01);but there was no significant difference in mean fALFF(mfALFF)value between the two groups.Correlation analysis showed that the mPerAF values of the right angular gyrus(r=-0.509,P=0.003)and the left supramarginal gyrus(r=-0.40

关 键 词：肾功能衰竭 慢性 磁共振成像 认知障碍 血液透析 

分 类 号：R445.2[医药卫生—影像医学与核医学] R692.5[医药卫生—诊断学]