首次透析前终末期肾病患者脑功能改变与认知功能障碍的相关性OA
Altered functional connectivity and its association with cognitive impairment in pre-dialysis end-stage renal disease
目的 利用静息态功能磁共振成像(rs-fMRI)的比例低频波动振幅(fALFF)及功能连接(FC)算法,探讨首次透析前终末期肾病(ESRD)患者脑功能改变,进一步分析脑功能改变与认知评分间的相关性.方法 选取2023年4月～2025年3月在本院就诊的拟行肾脏替代治疗的ESRD患者48例(ESRD组),同期招募相匹配的健康志愿者44例(对照组).所有受试者均进行rs-fMRI序列扫描及认知功能评估(MoCA),比较两组的fALFF的差异,并以上述差异脑区作为感兴趣区,使用FC分析研究感兴趣区与全脑体素之间的功能整合模式;在控制年龄、性别及受教育程度的影响后,分别对差异脑区的fALFF值及FC值与MoCA评分进行偏相关分析.结果 ESRD组患者MoCA评分低于对照组(P<0.001);与对照组比较,ESRD患者右侧楔前叶fALFF值减低(t=-5.445,团块水平FWE校正,P<0.05,团块体素≥67);FC分析发现,ESRD患者右侧楔前叶与右侧缘上回、右侧中扣带回的FC降低,但与右侧额中回的FC增加;在控制性别、年龄和教育水平后,右侧楔前叶与右侧缘上回的FC值与ESRD患者MoCA评分呈正相关(P<0.05).结论 静息状态下ESRD患者默认模式网络的脑自发活动及功能连接发生改变,并与认知功能密切相关,这些发现为理解首次透析前ESRD相关认知功能障碍的神经病理生理机制提供了新的影像学证据.
Objective To investigate alterations in brain function in patients with end-stage renal disease(ESRD)prior to their first dialysis using the fractional amplitude of low-frequency fluctuation(fALFF)and functional connectivity(FC)analyses of resting-state functional magnetic resonance imaging(rs-fMRI),and to further analyze the correlation between these brain functional changes and cognitive scores.Methods Forty-eight ESRD patients(ESRD group)scheduled for renal replacement therapy were recruited from our hospital from April 2023 to March 2025,along with 44 matched healthy volunteers(control group).All participants underwent rs-fMRI scanning and cognitive assessment using the Montreal Cognitive Assessment(MoCA).fALFF differences between the two groups were compared.Brain regions showing significant differences were used as regions of interest(ROIs)for subsequent FC analysis to investigate the functional integration patterns between these ROIs and whole-brain voxels.After controlling for the effects of age,gender,and education level,partial correlation analyses were conducted between the fALFF values/FC values of the identified brain regions and the MoCA scores.Results The MoCA scores were significantly lower in the ESRD group compared to the control group(P<0.001).Compared with controls,ESRD patients showed decreased fALFF values in PCUN.R(t=-5.445,Cluster-level FWE correction,P<0.05,with clusters comprising a minimum of 67 voxels).FC analysis revealed that ESRD patients had decreased FC between PCUN.R and SMG.R(P<0.001,uncorrected)as well as DCG.R(P<0.001,uncorrected),but increased FC between PCUN.R and MFG.R(P<0.001,uncorrected).After controlling for gender,age,and education level,the FC value between PCUN.R and SMG.R showed a significant positive correlation with the MoCA score of ESRD patients(r=0.346,P<0.05,FDR-corrected,k=4).Conclusion Patients with ESRD exhibit altered spontaneous brain activity and functional connectivity within the default mode network(DMN)at rest,which are closely associated with cognitive function.These findings provide novel neuroimaging evidence for understanding the neuropathophysiological mechanisms underlying cognitive impairment associated with ESRD prior to the initiation of dialysis.
张盼;张桂荣;张明;丁墩
西安交通大学第二附属医院医学影像科,陕西 西安 710004西安交通大学第二附属医院医学影像科,陕西 西安 710004西安交通大学第一附属医院医学影像科,陕西 西安 710061西安交通大学第二附属医院医学影像科,陕西 西安 710004
终末期肾病静息态功能磁共振成像比例低频波动幅度功能连接认知功能障碍
end-stage renal diseaseresting-state functional MRIfractional amplitude of low frequency fluctuationfunctional connectivitycognitive dysfunction
《分子影像学杂志》 2026 (2)
205-210,6
陕西省自然科学基础研究一般项目(青年项目)(2022JQ-900)
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