CAJ | 학술논문

目的采用低频振荡振幅(ALFF)算法静息态fMRI(rs-fMRI)研究终末期肾病(ESRD)血液透析(HD)患者脑功能改变特点.方法对64例ESRD血液透析(HD-ESRD组)患者和45名年龄、性别相匹配的健康志愿者(正常对照组)行rs-fMRI.对所有受试者进行神经心理测试[数字连接试验A(NCT-A)和数字符号试验(DST)]评估其认知功能;检查HD-ESRD组血肌酐、尿素等.采用统计参数图(SPM)8及REST 1.6软件分析2组受试者数据得到ALFF图.对HD-ESRD组和正常对照组ALFF值分别进行组内单样本t检验以及组间两样本t检验,并提取组间差异性脑区ALFF值与神经心理测试结果、病程、透析时程和实验室检查指标进行Pearson相关分析.结果 2组受试者的双侧楔前叶、额上回、额中回、顶下小叶、楔叶和颞上回等脑区ALFF值均高于全脑平均水平.与正常对照组相比,HD-ESRD组的双侧楔前叶、额叶、颞中回及右侧顶下小叶等脑区ALFF值减低(体素体积为270～6 804 mm3,t值为-7.41～-3.78,P值均＜0.01).HD-ESRD患者右侧额中回ALFF值与DST分值呈正相关(r=0.273,P＜0.05);左、右楔前叶,左侧缘上回和左侧额内侧回ALFF值与患者肾病病程呈负相关(r值分别为-0.301、-0.278、-0.298和-0.287,P值均＜0.05);ALFF值与患者的NCT-A值、血肌酐值、尿素值和透析时程无相关性(P值均＞0.05).结论 HD-ESRD患者存在多个脑区ALFF值的异常,主要位于脑默认网络分布区,提示存在自发脑活动损伤,且与肾病病程有关.
목적 채용저빈진탕진폭(ALFF)산법정식태fMRI(rs-fMRI)연구종말기신병(ESRD)혈액투석(HD)환자뇌공능개변특점.방법 대64례ESRD혈액투석(HD-ESRD조)환자화45명년령、성별상필배적건강지원자(정상대조조)행rs-fMRI.대소유수시자진행신경심리측시[수자련접시험A(NCT-A)화수자부호시험(DST)]평고기인지공능;검사HD-ESRD조혈기항、뇨소등.채용통계삼수도(SPM)8급REST 1.6연건분석2조수시자수거득도ALFF도.대HD-ESRD조화정상대조조ALFF치분별진행조내단양본t검험이급조간량양본t검험,병제취조간차이성뇌구ALFF치여신경심리측시결과、병정、투석시정화실험실검사지표진행Pearson상관분석.결과 2조수시자적쌍측설전협、액상회、액중회、정하소협、설협화섭상회등뇌구ALFF치균고우전뇌평균수평.여정상대조조상비,HD-ESRD조적쌍측설전협、액협、섭중회급우측정하소협등뇌구ALFF치감저(체소체적위270～6 804 mm3,t치위-7.41～-3.78,P치균＜0.01).HD-ESRD환자우측액중회ALFF치여DST분치정정상관(r=0.273,P＜0.05);좌、우설전협,좌측연상회화좌측액내측회ALFF치여환자신병병정정부상관(r치분별위-0.301、-0.278、-0.298화-0.287,P치균＜0.05);ALFF치여환자적NCT-A치、혈기항치、뇨소치화투석시정무상관성(P치균＞0.05).결론 HD-ESRD환자존재다개뇌구ALFF치적이상,주요위우뇌묵인망락분포구,제시존재자발뇌활동손상,차여신병병정유관.
Objective To investigate the changes of brain functions in hemodialysis (HD) patients with end-stage renal disease (ESRD) using resting-state functional magnetic resonance imaging (rs-fMRI) with amplitude of low frequency fluctuation (ALFF)algorithm.Methods Sixty-four HD-ESRD patients and forty-five sex and age-matched healthy controls were included in the rs-fMRI study.All subjects were given neuropsychological tests [number connection type-A (NCT-A) and digit symbol test (DST)] to evaluate cognitive function.Laboratory tests,including serum creatinine and urea,were performed in all HD-ESRD patients.SPM8 and REST1.6 software were used to process the data and to generate all subjects' ALFF maps.One-sample t test was performed to show the spatial pattern of ALFF in each group.Two-sample t test was used to determine the ALFF differences between patients and healthy controls.In addition,Pearson correlation analysis was performed among the ALFF values of significant brain regions and neuropsychological test scores,disease and dialvsis durations,serum creatinine and urea levels.Results Within each group,bilateral precuneus,superior frontal gyrus,middle frontal gyrus,inferior parietal lobule,cuneus and superior temporal gy rus showed higher ALFF values than the global mean ALFF value.Compared with the healthy controls,HD-ESRD patients presented decreased ALFF in bilateral precuneus,frontal lobes,middle temporal gyrus,and right inferior parietal lobule (voxel volumes:270-6 804 mm3,t =-7.41--3.78,all P＜0.01).The DST scores of HD-ESRD patients positively correlated with ALFF values in right middle frontal gyrus (r=0.273,P＜0.05).The disease durations negatively correlated with ALFF values in bilateral precuneus,left supramarginal gyrus and left medial frontal gyrus (r =-0.301,-0.278,-0.298,-0.287,allP＜0.05).The dialysis durations,NCT-A values,serum creatinine and urea levels of HD-ESRD patients showed no significant correlation with ALFF values (all P＞0.05).Conclusions HD-ESRD patients have abnormal ALFF values in several brain areas mainly located in default mode network (DMN),suggesting impaired spontaneous neural activity in HD-ESRD patients,and disease durations might be a risk factor for impaired spontaneous neural activity in HD-ESRD patients.