Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, Jiangsu, China.
Department of Endocrinology, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, China.
Eur Radiol. 2019 Oct;29(10):5577-5589. doi: 10.1007/s00330-019-06164-1. Epub 2019 Apr 1.
This study was conducted in order to investigate the topological organization of functional and structural brain networks in diabetic kidney disease (DKD) and its potential clinical relevance.
Two hundred two subjects (62 DKD patients, 60 diabetes mellitus [DM] patients, and 80 healthy controls) underwent laboratory examination, neuropsychological test, and magnetic resonance imaging (MRI). Large-scale functional and structural brain networks were constructed and graph theoretical network analyses were performed. The effect of renal function on brain functional and structural networks in DKD patients was further evaluated. Correlations were performed between network properties and neuropsychological scores and clinical variables.
Progressing deteriorated global and local network topology organizations (especially for functional network) were observed for DKD patients compared with control subjects (all p < 0.05, Bonferroni-corrected), with intermediate values for the patients with DM. DKD patients showed normally appearing functional-structural coupling compared with controls, while DM patients manifested functional-structural decoupling (p < 0.05, Bonferroni-corrected). Impaired kidney function markedly affected functional and structural network organization in DKD patients (all p < 0.05). Urea nitrogen correlated with global and local efficiency in the structural networks (r = - 0.551, p < 0.001; r = - 0.476, p < 0.001, respectively). Global and local efficiency in the structural networks and normalized characteristic path length in the functional networks were associated with information processing speed and/or psychomotor speed.
DKD patients showed enhanced functional and structural brain network disruption and normally appearing functional-structural coupling compared with DM patients, which correlated with kidney function, renal toxins, and cognitive performance.
• DKD patients showed markedly disrupted functional and structural brain network efficiency measures compared with DM patients and healthy controls. • Reduced kidney function clearly deteriorated functional and structural brain networks in DKD patients. • DKD patients displayed normally appearing functional-structural coupling compared with DM patients.
本研究旨在探讨糖尿病肾病（DKD）患者脑功能和结构网络的拓扑组织及其潜在的临床相关性。
202 例受试者（62 例 DKD 患者、60 例糖尿病患者和 80 例健康对照者）接受了实验室检查、神经心理学测试和磁共振成像（MRI）检查。构建了大规模的脑功能和结构网络，并进行了图论网络分析。进一步评估了 DKD 患者肾功能对脑功能和结构网络的影响。对网络特性与神经心理学评分和临床变量进行了相关性分析。
与对照组相比，DKD 患者的全局和局部网络拓扑结构组织逐渐恶化（尤其是功能网络，均 p<0.05，经 Bonferroni 校正），DM 患者的网络组织处于中间状态。与对照组相比，DKD 患者表现出正常的功能-结构耦合，而 DM 患者表现出功能-结构解耦（p<0.05，经 Bonferroni 校正）。肾功能受损显著影响 DKD 患者的功能和结构网络组织（均 p<0.05）。尿素氮与结构网络中的全局和局部效率呈负相关（r=-0.551，p<0.001；r=-0.476，p<0.001）。结构网络中的全局和局部效率以及功能网络中的标准化特征路径长度与信息处理速度和/或运动速度相关。
与 DM 患者和健康对照者相比，DKD 患者的脑功能和结构网络破坏明显增强，且功能-结构耦合正常，这与肾功能、肾毒素和认知表现相关。
• DKD 患者的脑功能和结构网络效率指标明显低于 DM 患者和健康对照组。• 肾功能降低明显恶化了 DKD 患者的脑功能和结构网络。• DKD 患者与 DM 患者相比，表现出正常的功能-结构耦合。
