维持性血液透析患者脑血流灌注改变与脑网络有效连接变化研究  

Changes in Cerebral Blood Flow Perfusion and Effective Connectivity in Brain Networks of Maintenance Hemodialysis Patients

作　　者：吴宇[1] 邱翔 秦梦[2] 阿白 WU Yu;QIU Xiang;QIN Meng;A Bai(Department of Radiology,Chengdu Integrated TCM&Western Medicine Hospital,Chengdu First People's Hospital,Chengdu 610041,Sichuan Province,China;Blood Purification Center,Affiliated Hospital of North Sichuan Medical College,Nanchong 637000,Sichuan Province,China;Department of Radiology,Dege County People's Hospital,Dege 627250,Sichuan Province,China)

机构地区：[1]成都市第一人民医院/成都市中西医结合医院放射科,四川成都610041 [2]川北医学院附属医院血液净化中心,四川南充637000 [3]德格县人民医院放射科,四川德格627250

出　　处：《中国CT和MRI杂志》2024年第8期4-7,共4页Chinese Journal of CT and MRI

基　　金：成都市医学科研课题(2022433)。

摘　　要：目的采用脑血流灌注(CBF)和格兰杰因果分析(GCA)方法研究终末期肾病(ESRD)维持性血液透析(MHD)患者脑血流灌注改变及与全脑连接效应特点,揭示这些脑血流灌注变化与MHD患者认知功能障碍之间的潜在联系。方法本研究纳入29例MHD患者和29例对照组(HC组)。所有受试者行功能磁共振检查,获得的两组间血流灌注的差异脑区作为种子点,并基于格兰杰因果分析观察静息态功能磁共振成像所示种子点与全脑效应连接异常脑区,并将MHD患者异常脑区与临床数据资料和神经心理学测试结果进行相关分析。结果MHD组双侧海马、右侧脑岛的CBF值较HC组减低(P<0.05,FDR校正)。MHD组右侧脑岛CBF值与肌酐(Cr)呈负相关(P<0.05)。MHD组右侧海马到右侧三角部额下回连接效应增加。MHD组左侧海马到右侧距状裂周围皮层、右侧豆状壳核、右侧前扣带和旁扣带脑回、右侧脑岛连接效应增加,左侧海马到左侧丘脑连接效应减低(P<0.05,FDR校正)。MHD组右侧海马至右侧三角部额下回连接效应与血尿素氮(BUN)呈正相关(P<0.05),MHD组左侧海马至右侧前扣带和旁扣带脑回连接效应与命名评分呈正相关(P<0.05),左侧海马至右侧豆状壳核连接效应与抽象评分、透析时间呈负相关,左侧海马至左侧丘脑连接效应与命名评分呈负相关(P<0.05)。结论终末期肾病维持性血液透析患者存在脑血流灌注异常及双侧海马与全脑效应连接异常,并参与认知功能调节。Objective This study employs cerebral blood flow(CBF)measurements and Granger causality analysis(GCA)to investigate the alterations in CBF and the effects on whole-brain connectivity in patients with end-stage renal disease(ESRD)undergoing maintenance hemodialysis(MHD).Additionally,it aims to examine the correlation between these alterations and cognitive impairments in MHD patients.Methods This study included 29 MHD patients and an equal number of healthy controls,matched for age and gender,designated as the HC group.Functional magnetic resonance imaging was performed on all subjects,and the difference in blood flow perfusion between the two groups was used as a seed point for GCA analysis to observe the abnormal brain areas connected with the seed point shown in resting-state functional magnetic resonance imaging,and to correlate it with the clinical data and neuropsychological test results of MHD patients.Results Compared to the healthy control(HC)group,the MHD group showed significantly reduced cerebral blood flow(CBF)in the bilateral hippocampus and right insula(P<0.05,FDR corrected).In the MHD group,the CBF in the right insula was negatively correlated with creatinine levels(P<0.05).The MHD group also exhibited an increased connectivity effect from the right hippocampus to the right triangular inferior frontal gyrus.Additionally,connectivity from the left hippocampus to several regions,including the right calcarine fissure and surrounding cortex,right anterior cingulate and paracingulate gyrus,and right putamen and insula,was enhanced.Conversely,the connectivity from the left hippocampus to the left thalamus was reduced(P<0.05,FDR corrected).Furthermore,the connectivity from the right hippocampus to the right triangular inferior frontal gyrus was found to be positively correlated with blood urea nitrogen(BUN)levels in the MHD group(P<0.05).The connectivity from the left hippocampus to the right anterior cingulate and paracingulate gyrus correlated positively with naming scores.However,the connectivity to th

关 键 词：终末期肾病 维持性血液透析 脑血流灌注 格兰杰因果分析 认知功能障碍 

分 类 号：R692[医药卫生—泌尿科学]