非认知障碍终末期肾病患者脑结构与功能磁共振成像研究  

A Magnetic Resonance Imaging Study of Brain Structure and Function in Non-Cognitive Impairment End-Stage Renal Disease

作　　者：陈诗桦 谭理连[1] 张鹏 陈正[2] CHEN Shihua;TAN Lilian;ZHANG Peng(Department of Radiology,Organ Transplant Center,The Second Affiliated Hospital of Guangzhou Medical University,Guangzhou,Guangdong Province 510260,P.R.China)

机构地区：[1]广州医科大学附属第二医院放射科,510260 [2]广州医科大学附属第二医院移植科,510260

出　　处：《临床放射学杂志》2025年第5期802-807,共6页Journal of Clinical Radiology

基　　金：广州市科技计划基金项目(编号:2024A03J0191);广东省医学科研基金项目(编号:A2022250);广州市临床重大特色技术项目(编号:穗卫医政[2019]14号30号)。

摘　　要：目的基于多模态磁共振成像技术探讨非认知障碍终末期肾病(Non-CI ESRD)患者的脑结构与功能变化。方法采集30例Non-CI ESRD患者和31名健康对照者的三维高分辨率T1WI(3D-T1WI)脑结构成像和脑静息态功能磁共振成像(rs-fMRI)数据。基于体素形态学测量(VBM)、基于表面形态学测量(SBM)、低频振幅(ALFF)与局部一致性(ReHo)方法评价Non-CI ESRD患者的脑结构与功能变化。结果Non-CI ESRD患者在左侧颞极:颞上回、额下回眶部、内侧额上回、舌回、直回及右侧距状裂周围皮层、海马旁回灰质体积减小;在左侧背外侧额上回、额下回眶部、岛叶,右侧楔前叶、颞上回、舌回及双侧额下回三角部、额中回、中央前回皮层厚度缩小;无灰质体积增加及皮层厚度增加的脑区。Non-CI ESRD患者在双侧梭状回、左侧舌回ALFF值升高,在双侧楔前叶、右侧角回及颞中回ALFF值下降;在左侧梭状回及舌回ReHo值升高,在双侧额上回及额中回、左侧前扣带回、右侧内侧额上回ReHo值下降。结论ESRD患者在尚未出现认知障碍时,就存在多个脑区的灰质形态学变化与自发性脑功能活动异常。VBM、SBM、ALFF、ReHo分析方法在评估ESRD患者早期脑结构与功能异常方面具有显著的应用潜力。Objective To explore the changes in brain structure and function in patients with non-cognitive impairment end-stage renal disease(Non-CI ESRD)based on multimodal magnetic resonance imaging techniques.Methods The high-resolution T 1WI brain structural imaging(3D-T 1WI)and resting-state brain functional imaging(rs-fMRI)data of 30 Non-CI ESRD patients and 31 healthy controls were collected.The changes in brain structure and function of Non-CI ESRD patients were evaluated using voxel-based morphometry(VBM),surface-based morphometry(SBM),amplitude of low-frequency fluctuations(ALFF),and regional homogeneity(ReHo)methods.Results Non-CI ESRD patients showed decreased gray matter volume in the left temporal pole:superior temporal gyrus,inferior frontal gyrus(orbital part),superior frontal gyrus(medial),lingual gyrus,gyrus rectus,and in the right calcarine fissure and surrounding cortex,parahippocampal gyrus;cortical thickness was reduced in the left superior frontal gyrus(dorsolateral),inferior frontal gyrus(orbital part),insula,and in the right precuneus,superior temporal gyrus,lingual gyrus,and in the bilateral inferior frontal gyrus(triangular part),medial frontal gyrus,precentral gyrus.No brain regions with increased gray matter volume or cortical thickness were found.Non-CI ESRD patients had increased ALFF values in the bilateral fusiform gyrus and left lingual gyrus,and decreased ALFF values in the bilateral precuneus,right angular gyrus,and middle temporal gyrus;ReHo values were increased in the left fusiform gyrus and lingual gyrus,and decreased in the bilateral superior frontal gyrus,middle frontal gyrus,left anterior cingulate gyrus,and right medial superior frontal gyrus.Conclusion Patients with ESRD exhibit changes in brain structure and function before the appearance of cognitive impairment.The VBM,SBM,ALFF,and ReHo analysis methods have demonstrated significant potential in evaluating early brain structure and function abnormalities in patients with ESRD.

关 键 词：终末期肾病 认知 脑结构 脑功能 

分 类 号：R692[医药卫生—泌尿科学]