Ma C, Gao S, Li W, Yu L, Fu S L, Ren Y D
Department of Radiology, the Affiliated Hospital of Qingdao University, Qingdao, 266555, China.
Zhonghua Yi Xue Za Zhi. 2021 Jan 26;101(4):265-270. doi: 10.3760/cma.j.cn112137-20200513-01524.
To investigate the changes of spontaneous brain activity in patients with end-stage renal disease (ESRD) by combining three different resting state functional magnetic resonance low frequency amplitude algorithms, including amplitude of low-frequency fluctuations (ALFF), fractional amplitude of low-frequency fluctuations (fALFF), and percent amplitude of fluctuation (PerAF), and to analyze the associations between spontaneous brain activity changes and clinical variables. The data of 31 ESRD patients treated with maintenance hemodialysis and 37 healthy volunteers in the Department of Nephrology and Renal Transplantation of the Affiliated Hospital of Qingdao University from August 2018 to December 2019 were retrospectively collected. The resting state functional magnetic resonance imaging (rs-fMRI) scan was performed to calculate the ALFF, fALFF, and PerAF values of the whole brain of the subjects in each group. Independent sample test was used for comparison between groups, and Pearson correlation analysis was used to investigate the correlation between spontaneous brain activity changes in brain regions with significant differences and clinical variables. Compared to healthy volunteers, patients with ESRD had decreased mean ALFF(mALFF) values of the right lingual gyrus, bilateral anterior precuneus, left inferior frontal gyrus, and right middle cingulate gyrus (FDR (false discovery rate) correction, all 0.01); and decreased mean PerAF (mPerAF) values of the bilateral anterior precuneus, bilateral posterior cingulate cortex, right calcarine fissure and surrounding cortex, bilateral inferior parietal lobule/temporoparietal junction (including bilateral angular gyrus, middle temporal gyrus, left supramarginal gyrus), and bilateral inferior frontal gyrus (FDR (false discovery rate) correction, all 0.01); but there was no significant difference in mean fALFF (mfALFF) value between the two groups. Correlation analysis showed that the mPerAF values of the right angular gyrus (=-0.509, =0.003) and the left supramarginal gyrus (=-0.405, =0.024) were negatively correlated with serum potassium concentration in ESRD patients, while mALFF values of the bilateral anterior precuneus (=0.058, =0.004) and mPerAF values of the left gyrus (=0.415, =0.020) were positively correlated with hemoglobin level. In ESRD patients, spontaneous brain activity was reduced in multiple brain regions, mainly located in default mode network(DMN), which might be the underlying pathophysiological mechanisms of their brain damage. Controlling serum potassium and hemoglobin levels was essential to prevent the progression of brain damage in ESRD patients.
通过结合三种不同的静息态功能磁共振低频振幅算法，即低频波动幅度（ALFF）、低频波动分数振幅（fALFF）和波动百分比振幅（PerAF），研究终末期肾病（ESRD）患者的自发脑活动变化，并分析自发脑活动变化与临床变量之间的关联。回顾性收集了2018年8月至2019年12月在青岛大学附属医院肾内科及肾移植科接受维持性血液透析的31例ESRD患者和37名健康志愿者的数据。进行静息态功能磁共振成像（rs-fMRI）扫描，以计算每组受试者全脑的ALFF、fALFF和PerAF值。采用独立样本检验进行组间比较，采用Pearson相关分析研究脑区自发脑活动变化与临床变量之间的相关性。与健康志愿者相比，ESRD患者右侧舌回、双侧前楔叶、左侧额下回和右侧中央扣带回的平均ALFF（mALFF）值降低（FDR（错误发现率）校正，均<0.01）；双侧前楔叶、双侧后扣带回皮质、右侧距状裂及周围皮质、双侧顶下小叶/颞顶交界区（包括双侧角回、颞中回、左侧缘上回）和双侧额下回的平均PerAF（mPerAF）值降低（FDR（错误发现率）校正，均<0.01）；但两组间平均fALFF（mfALFF）值无显著差异。相关分析显示，ESRD患者右侧角回（r=-0.509，P=0.003）和左侧缘上回（r=-0.405，P=0.024）的mPerAF值与血清钾浓度呈负相关，而双侧前楔叶的mALFF值（r=0.58，P=0.004）和左侧回的mPerAF值（r=0.415，P=0.020）与血红蛋白水平呈正相关。在ESRD患者中，多个脑区的自发脑活动减少，主要位于默认模式网络（DMN），这可能是其脑损伤的潜在病理生理机制。控制血清钾和血红蛋白水平对于预防ESRD患者脑损伤的进展至关重要。
