Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, 305 Zhongshan East Road, Xuanwu District, Nanjing, Jiangsu Province, 210002, China,
Metab Brain Dis. 2013 Dec;28(4):647-54. doi: 10.1007/s11011-013-9438-7. Epub 2013 Sep 26.
To investigate the pattern of brain volume changes in patients with end-stage renal disease (ESRD) using voxel-based morphometry (VBM) and correlation with clinical and neuropsychological (NP) tests. Fifty seven ESRD patients with no anatomical abnormalities in conventional magnetic resonance imaging [24 patients with abnormal NP scores, 16 male, 39 ± 12 years; 33 patients with normal NP scores, 23 male, 35 ± 9.7 years] and 22 age- and gender-matched healthy controls (14 male, 36 ± 10.1 years) were recruited in this study. Results from VBM analysis were analyzed with ANOVA test among 3 groups (controls, minimal nephro-encephalopathy group, non-nephro-encephalopathy group). Multiple linear regression analysis was used to investigate the effect of serum urea and creatinine, and dialysis duration on the brain volumes in ESRD patients. Correlation analysis was performed to investigate the association between NP scores with the brain volumes in ESRD patients. Compared with healthy controls, ESRD patients showed diffusely decreased gray matter volume that further decreased in the presence of encephalopathy. Multiple linear regression results showed that serum urea was negatively associated with changes in gray matter volume in many regions, while dialysis duration was negatively associated with some white matter volume changes (All P < 0.05, AlphaSim correction). NP scores correlated with some decreased gray matter volume in ESRD patients (All P < 0.05, AlphaSim correction). No correlation was found between white matter volume and any NP test scores in ESRD patients. This study found predominantly decreased gray matter volume in ESRD patients, which was associated with neurocognitive dysfunction. Serum urea level may be a risk factor for decreased gray matter in ESRD patients.
采用基于体素的形态测量学(VBM)研究终末期肾病(ESRD)患者脑容量变化的模式，并与临床和神经心理学(NP)测试相关联。
本研究纳入了 57 名 ESRD 患者（24 名 NP 评分异常，16 名男性，39±12 岁；33 名 NP 评分正常，23 名男性，35±9.7 岁）和 22 名年龄和性别匹配的健康对照者（14 名男性，36±10.1 岁）。对 3 组（对照组、轻度肾性脑病组、非肾性脑病组）的 VBM 分析结果进行方差分析。采用多元线性回归分析探讨血清尿素和肌酐以及透析时间对 ESRD 患者脑容量的影响。进行相关性分析以探讨 ESRD 患者 NP 评分与脑容量之间的相关性。
与健康对照组相比，ESRD 患者表现出弥漫性灰质体积减少，在出现脑病时进一步减少。多元线性回归结果显示，血清尿素与许多区域的灰质体积变化呈负相关，而透析时间与某些白质体积变化呈负相关（均 P<0.05，AlphaSim 校正）。NP 评分与 ESRD 患者部分灰质体积减少呈正相关（均 P<0.05，AlphaSim 校正）。在 ESRD 患者中，未发现白质体积与任何 NP 测试评分之间存在相关性。
本研究发现 ESRD 患者主要表现为灰质体积减少，这与神经认知功能障碍有关。血清尿素水平可能是 ESRD 患者灰质减少的危险因素。
