Zheng Gang, Wen Jiqiu, Zhang Liping, Zhong Jianhui, Liang Xue, Ke Wenwei, Kong Xiang, Zhao Tiezhu, He Yong, Zuo Xinian, Luo Song, Zhang Long Jiang, Lu Guang Ming
Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, 210002, China.
Metab Brain Dis. 2014 Sep;29(3):777-86. doi: 10.1007/s11011-014-9568-6. Epub 2014 May 21.
The changes of whole brain functional connectivity in hemodialysis (HD) patients with end-stage renal disease (ESRD) are still unclear, which may be associated with multiple factors, such as elevated neurotoxins, anemia, and side effects of hemodialysis. Resting-state functional magnetic resonance imaging (rs-fMRI) data of 71 patients (43 males, 28 females; mean age, 33.4 ± 9.4 years) and 43 age- and gender-matched healthy volunteers (29 males, 14 females; mean age, 30.6 ± 8.8 years) were acquired. Neuropsychological tests including number connection test type A (NCT-A), digit symbol test (DST), line-tracing test (LTT), serial-dotting test (SDT), self-rating depression scale (SDS) and self-rating anxiety scale (SAS) were used to evaluate cognitive and psychiatric conditions in all subjects. Blood biochemistry tests including serum creatinine levels, blood urea, hematocrit, and Ca(2+) level were taken in HD patients. Forty-two connections significantly different between HD patients with ESRD and controls were found (all P < 0.05, Bonferroni corrected) and identified as connectivities of interests (COIs), among which 39 connections (92.9%) were markedly decreased in patients. Of the 39 weaker connections, 24 were related to the frontal lobe regions. Widespread weakening of cortical and subcortical network connectivity in ESRD patients was more directly related with neuropsychological impairments and anemia rather than serum creatinine level, blood urea and dialysis duration. In particular, impairments in the medial prefrontal lobe could play an important role in mediating psychological dysfunctions.
终末期肾病（ESRD）血液透析（HD）患者全脑功能连接的变化仍不清楚，这可能与多种因素有关，如神经毒素升高、贫血和血液透析的副作用。采集了71例患者（43例男性，28例女性；平均年龄33.4±9.4岁）和43名年龄及性别匹配的健康志愿者（29例男性，14例女性；平均年龄30.6±8.8岁）的静息态功能磁共振成像（rs-fMRI）数据。使用包括数字连接试验A（NCT-A）、数字符号试验（DST）、划线试验（LTT）、连续打点试验（SDT）、自评抑郁量表（SDS）和自评焦虑量表（SAS）在内的神经心理学测试来评估所有受试者的认知和精神状况。对HD患者进行了包括血清肌酐水平、血尿素、血细胞比容和Ca（2+）水平在内的血液生化检查。发现ESRD的HD患者与对照组之间有42个连接存在显著差异（所有P<0.05，经Bonferroni校正），并将其确定为感兴趣的连接（COIs），其中39个连接（92.9%）在患者中明显减少。在这39个较弱的连接中，24个与额叶区域有关。ESRD患者皮质和皮质下网络连接的广泛减弱与神经心理学损害和贫血的关系更为直接，而不是与血清肌酐水平、血尿素和透析时间有关。特别是，内侧前额叶的损害可能在介导心理功能障碍中起重要作用。
