终末期肾病患者脑白质改变与认知功能的相关性研究  

Correlation between alterations in white matteRand cognitive function in patients with end-stage renal disease

作　　者：刘雅睿 齐向明[2] 方杰 邹帆 缪莹莹 王海宝[1] Liu Yarui;Qi Xiangming;Fang Jie;Zou Fan;Miao Yingying;Wang Haibao(Dept of Radiology,The First Affiliated Hospital of Anhui Medical University,Hefei 230022;Dept of Nephrology,The First Affiliated Hospital of Anhui Medical University,Hefei 230022)

机构地区：[1]安徽医科大学第一附属医院放射科,合肥230022 [2]安徽医科大学第一附属医院肾脏内科,合肥230022

出　　处：《安徽医科大学学报》2022年第10期1670-1675,共6页Acta Universitatis Medicinalis Anhui

基　　金：安徽省自然科学基金(编号:1908085MH245);安徽高校自然科学研究项目(编号:KJ2018A0493)。

摘　　要：目的探究终末期肾病(ESRD)患者脑白质结构与认知功能及血液生化指标的相关性。方法收集64例ESRD患者和47例年龄、性别相匹配的健康对照者的弥散张量成像(DTI)数据,应用基于纤维束追踪的空间统计方法(TBSS)及XTRACT分析方法比较两组间扩散参数差异。应用Pearson相关分析检测各项扩散参数与血液生化指标及认知相关量表之间的相关性。结果与对照组相比,ESRD组的FA值下降(P<0.05),MD、AD及RD值增高(P<0.05),简易智力状况检查(MMSE)、蒙特利尔认知评估量表(MoCA)评分均下降(P<0.01),连线实验A部分(TMT-A)评分增高(P<0.05)。ESRD患者的右侧丘脑前辐射、视辐射、听辐射及扣带束等白质束的FA值与肌酐、尿素水平呈负相关,与MoCA评分呈正相关,其MD、RD值与尿素水平呈正相关;视辐射、听辐射及左扣带束颞部的FA值与TMT-A评分呈负相关;垂直枕束、下额枕束、左侧中纵束及大钳的FA值与肌酐水平呈负相关;左侧弓状束的FA值与MoCA评分呈正相关,其MD、RD值与肌酐水平呈正相关,与MMSE、MoCA评分呈负相关;右上纵束、右侧皮质脊髓束及右侧额斜束的FA值与MoCA评分呈正相关,MD、RD值与尿素水平呈正相关;左侧穹隆的MD、RD值与肌酐及尿素水平呈正相关。结论ESRD患者的脑白质结构完整性广泛受损,与多种认知功能障碍显著相关,血清尿素及肌酐可能是脑白质改变的危险因素。Objective To study the correlation between cerebral white matteRstructure with cognitive function and blood biochemical indexes in patients with end stage renal disease(ESRD).Methods The diffusion tensoRimaging(DTI)data of 64 ESRD patients and 47 age and sex matched healthy people were collected.Tract-based spatial statistics(TBSS)and XTRACT analysis methods were used to compare the differences in diffusion parameters between the two groups.Pearson correlation analysis was used to detect the correlation between various diffusion parameters and blood biochemical indexes and cognitive related scales.Results The values of FA in the ESRD group generally decreased(P<0.05).The values of MD,AD and RD obviously increased(P<0.05).The scores of mini mental state examination(MMSE)and Montreal cognitive assessment(MoCA)decreased(P<0.01),while that of trail making test A part(TMT-A)increased(P<0.05).In the ESRD group,the values of FA in the right anterioRthalamic radiation,optic radiation,acoustic radiation,and cingulum were negatively correlated with the levels of creatinine and urea nitrogen,and positively correlated with MoCA′s scores,and the values of MD and RD of these tracts were positively correlated with the concentration of urea.The values of FA in optic radiation,acoustic radiation and left temporal of cingulum were negatively correlated with the scores of TMT-A.The values of FA in the vertical occipital fasciculus,inferioRfronto-occipital fasciculus,left middle longitudinal fasciculus and forceps majoRwere negatively correlated with the concentration of creatinine.The values of FA in the left arcuate fasciculus were positively correlated with the MoCA′s score,the values of MD and RD of these tracts were positively correlated with the concentration of creatinine,and negatively correlated with the scores of MMSE and MoCA.The values of FA in the right superioRlongitudinal fasciculus,the right corticospinal tract and the right frontal aslant tract were positively correlated with the MoCA′s score,the values of MD

关 键 词：终末期肾病 认知 脑白质 弥散张量成像 

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]