中枢执行网络功能连接改变在终末期肾病患者轻度认知障碍中的临床诊断价值  

Clinical diagnostic value of altered functional connectivity in the central executive network on mild cognitive impairment in patients with end-stage renal disease

作　　者：李雯清 王荻 刘同强[2] 张万超 石海峰 Li Wenqing;Wang Di;Liu Tongqiang;Zhang Wanchao;Shi Haifeng(Department of Radiology,the Affiliated Changzhou Second People's Hospital of Nanjing Medical University,Changzhou 213000,China;Department of Nephrology,the Affiliated Changzhou Second People's Hospital of Nanjing Medical University,Changzhou 213000,China;Graduate College,Dalian Medical University,Dalian 116085,China;Department of Radiology,the People's Hospital of Wuqia of Xinjiang Uygur Autonomous Region,Kizilsu Kirghiz Autonomous Prefecture 845450,China)

机构地区：[1]南京医科大学附属常州市第二人民医院放射科,常州213000 [2]南京医科大学附属常州市第二人民医院肾内科,常州213000 [3]大连医科大学研究生院,大连116085 [4]新疆维吾尔自治区乌恰县人民医院放射科,克孜勒苏柯尔克孜自治州845450

出　　处：《中华行为医学与脑科学杂志》2024年第11期993-1000,共8页Chinese Journal of Behavioral Medicine and Brain Science

基　　金：新疆维吾尔自治区自然科学基金(2022D01A318);常州市科技计划项目(CE20235062);南京医科大学常州医学中心临床研究项目(CMCC202306)。

摘　　要：目的探究大脑中枢执行网络(central executive network,CEN)功能连接(functional connectivity,FC)改变在终末期肾病(end-stage renal disease,ESRD)患者轻度认知障碍(mild cognitive impairment,MCI)中的临床诊断价值。方法招募2020年6月至2023年12月期间在常州市第二人民医院肾内科接受血液透析治疗的155名ESRD患者,其中85例有MCI症状(ESRD伴MCI组),70例无MCI症状(ESRD不伴MCI组)。同时纳入年龄、性别和教育年限相匹配的76名健康志愿者(健康对照组)。所有被试均进行静息态功能磁共振扫描和蒙特利尔认知评估。以背外侧前额叶皮质为CEN的核心,采用基于种子的FC分析计算CEN的功能属性,并基于这些影像特征联合临床资料使用LASSO+Logistic回归构建预测ESRD患者MCI的临床诊断模型,统计软件为SPSS 20.0。结果三组间有10个脑区(颞下回、颞极、胼胝体、腹内侧前额叶皮质、腹侧后扣带回皮质、顶下小叶、楔前叶、背内侧前额叶皮质、背侧前扣带回皮质、辅助运动区)的FC差异有统计学意义(均P<0.001)。事后分析显示,ESRD伴MCI组中腹内侧前额叶皮质及背内侧前额叶皮质的zFC值(0.385±0.219,0.215±0.247)高于ESRD不伴MCI组(0.278±0.184,0.121±0.221)与健康对照组(0.206±0.217,0.078±0.212)(均P<0.05);除腹内侧前额叶皮质及背内侧前额叶皮质外,无论是ESRD伴MCI组[颞极(0.157±0.221比0.335±0.195)、胼胝体(0.100±0.184比0.327±0.191)、腹侧后扣带回(0.027±0.199比0.128±0.154)、顶下小叶(0.218±0.195比0.387±0.213)、楔前叶(0.193±0.184比0.358±0.142)、辅助运动区(0.182±0.163比0.231±0.163)],还是ESRD不伴MCI组[颞下回(0.055±0.125比0.250±0.146)、颞极(0.048±0.223比0.335±0.195)、胼胝体(0.192±0.161比0.327±0.191)、顶下小叶(0.234±0.197比0.387±0.213)、背侧前扣带回(0.383±0.242比0.585±0.195)、辅助运动区(0.076±0.162比0.231±0.163)],所有与健康对照组有显著差异的脑区zFC值均显著降低(均PObjectiveTo evaluate the clinical diagnostic significance of altered functional connectivity(FC)within the central executive network(CEN)in patients with mild cognitive impairment(MCI)related to end-stage renal disease(ESRD).MethodsA total of 155 patients with ESRD receiving hemodialysis treatment at the department of nephrology,Changzhou Second People's Hospital,from June 2020 to December 2023,were recruited.According to wether the patient had MCI symptoms,85 patients were classified in the ESRD with MCI group,while 70 patients were in the ESRD without MCI group.Additionally,76 healthy volunteers matched for age,sex,and years of education were enrolled in the study.All participants underwent resting-state functional magnetic resonance imaging and were evaluated using the Montreal cognitive assessment.With the dorsolateral prefrontal cortex serving the core of CEN,functional attributes of the CEN were calculated using seed-based FC analysis.Based on these imaging features and clinical data,a LASSO+Logistic regression model was constructed to predict MCI in patients with ESRD,and SPSS 20.0 software was used for analysis.ResultsThere were significant differences in FC in 10 brain regions,including the inferior temporal gyrus,temporal pole,corpus callosum,ventromedial prefrontal cortex,ventral posterior cingulate cortex,inferior parietal lobule,precuneus,dorsomedial prefrontal cortex,dorsal anterior cingulate cortex,and supplementary motor area,among the three groups(all P<0.001).Post hoc analysis revealed that the zFC values of the ventromedial prefrontal cortex and dorsomedial prefrontal cortex in ESRD with MCI group(0.385±0.219,0.215±0.247)were significantly higher than those in the ESRD without MCI group(0.278±0.184,0.121±0.221)and the healthy controls(0.206±0.217,0.078±0.212)(all P<0.05).In addition to the ventromedial prefrontal cortex and dorsomedial prefrontal cortex,zFC values in all brain regions exhibiting significant differences were markedly reduced in both the ESRD with MCI group(temporal pole(0.

关 键 词：终末期肾病 轻度认知障碍 静息态功能磁共振成像 中枢执行网络 

分 类 号：R692.5[医药卫生—泌尿科学] R749.1[医药卫生—外科学]