Department of Medical Imaging, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China.
Department of Medical Imaging, Nuclear Industry 215 Hospital of Shaanxi Province, Xianyang, Shaanxi, China.
Hum Brain Mapp. 2023 Feb 15;44(3):989-1001. doi: 10.1002/hbm.26122. Epub 2022 Oct 21.
Neurovascular (NV) decoupling is a potential neuropathologic mechanism of cognitive impairment in patients with end-stage renal disease (ESRD). Hemodialysis improves cognitive impairment at 24 h post-dialysis, which suggests a potential neuroprotective effect of hemodialysis treatment on the brain. We investigated the effects of hemodialysis treatment on the reversal of NV decoupling associated with cognitive improvement. A total of 39 patients with ESRD and 39 healthy controls were enrolled. All patients were imaged twice during a dialysis session: before hemodialysis (T1 ) and at 24 h after dialysis (T2 ). The healthy controls were imaged once. NV coupling was characterized based on correlation coefficients between four types of blood oxygen level-dependent signals and cerebral blood flow (CBF). A battery of neuropsychological and blood tests was performed before the imaging. Patients with ESRD showed improvements in memory and executive function at T2 compared with that at T1 . At both T1 and T2 , patients with ESRD had lower amplitude of low-frequency fluctuation (ALFF)-CBF coupling than healthy controls. Additionally, patients with ESRD had higher ALFF-CBF coupling at T2 than at T1 . Higher memory scores, higher hemoglobin level, lower total plasma homocysteine level, lower systolic blood pressure variance, and lower ultrafiltration volume were associated with higher ALFF-CBF coupling in patients with ESRD after a hemodialysis session. These findings indicate that partial correction of anemia and hyperhomocysteinemia, stable systolic blood pressure, and fluid restriction may be closely linked to the reversal of NV decoupling and improvement in cognition in patients with ESRD.
神经血管（NV）解偶联是终末期肾病（ESRD）患者认知障碍的潜在神经病理学机制。血液透析在透析后 24 小时改善认知障碍，这表明血液透析治疗对大脑具有潜在的神经保护作用。我们研究了血液透析治疗对与认知改善相关的 NV 解偶联逆转的影响。共纳入 39 例 ESRD 患者和 39 名健康对照者。所有患者在透析过程中进行了两次成像：血液透析前（T1）和透析后 24 小时（T2）。健康对照组仅进行了一次成像。NV 偶联基于四种血氧水平依赖信号与脑血流（CBF）之间的相关系数进行特征化。在成像前进行了一系列神经心理学和血液测试。与 T1 相比，ESRD 患者在 T2 时记忆和执行功能得到改善。在 T1 和 T2 时，ESRD 患者的低频波动（ALFF）-CBF 偶联振幅均低于健康对照组。此外，ESRD 患者在 T2 时的 ALFF-CBF 偶联高于 T1。血液透析后，ESRD 患者的记忆评分较高、血红蛋白水平较高、总血浆同型半胱氨酸水平较低、收缩压变异较小和超滤量较少，与 ALFF-CBF 偶联较高相关。这些发现表明，纠正贫血和高同型半胱氨酸血症、稳定的收缩压和限制液体可能与 ESRD 患者 NV 解偶联的逆转和认知改善密切相关。
