Chen Hui Juan, Qiu Jie, Xu Xiaoling, Guo Yihao, Fu Lili, Fu Qingqing, Wu Yanglei, Qi Yonghui, Chen Feng
Department of Radiology, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), No. 19, Xiuhua St, Xiuying Dis, Haikou, Hainan, 570311, People's Republic of China.
Department of Ultrasound, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), No. 19, Xiuhua St, Xiuying Dis, Haikou, Hainan, 570311, People's Republic of China.
Neurol Sci. 2023 Dec;44(12):4499-4509. doi: 10.1007/s10072-023-06912-8. Epub 2023 Jul 1.
Abnormal white matter has been reported in patients with end-stage renal disease (ESRD). However, few studies have investigated the relationship between specific damage segments and cognition in ESRD. This study aimed to delineate white matter alterations in ESRD and its relationship with cognition.
A total of 36 patients undergoing hemodialysis and 25 healthy controls underwent diffusion tensor imaging (DTI) and a series of neuropsychiatric tests. Automated fiber quantification was used to extract distinct DTI indices, and the relationship between the specific segment of the white matter and clinical properties was investigated. Furthermore, a support vector machine was applied to differentiate patients with ESRD from healthy controls.
Fractional anisotropy values decreased in multiple fiber bundles, including bilateral thalamic radiata, cingulum cingulate, inferior fronto-occipital fasciculus (IFOF), uncinate, Callosum_Forceps_Major/Callosum_Forceps_Minor (CFMaj/CFMin), and left uncinate from the tract level in patients with ESRD. Specific damaged segments were detected in 8 fiber bundles, including bilateral thalamic radiation, cingulum cingulate, IFOF, CFMin, and left corticospinal tract. Few alterations in these fiber bundles were correlated with cognition impairment and hemoglobin levels. The tract profiles of the left thalamic radiata and left cingulum cingulate could be used to differentiate hemodialysis patients from healthy controls, with an accuracy of 76.9% and 67.6%, respectively.
This study revealed white matter damage in hemodialysis patients. This damage occurred in specific segments of the tract, especially in the left thalamic radiata and left cingulum cingulate, which might become a new biomarker for patients with ESRD and cognition impairment.
已有报道称终末期肾病（ESRD）患者存在白质异常。然而，很少有研究调查ESRD中特定损伤节段与认知之间的关系。本研究旨在描绘ESRD中的白质改变及其与认知的关系。
共36例接受血液透析的患者和25名健康对照者接受了扩散张量成像（DTI）和一系列神经精神测试。采用自动纤维定量法提取不同的DTI指标，并研究白质特定节段与临床特征之间的关系。此外，应用支持向量机区分ESRD患者和健康对照者。
ESRD患者多个纤维束的各向异性分数值降低，包括双侧丘脑辐射、扣带束、额枕下束（IFOF）、钩束、胼胝体主要/次要钳（CFMaj/CFMin）以及左侧钩束。在8个纤维束中检测到特定的损伤节段，包括双侧丘脑辐射、扣带束、IFOF、CFMin和左侧皮质脊髓束。这些纤维束的少量改变与认知障碍和血红蛋白水平相关。左侧丘脑辐射和左侧扣带束的纤维束轮廓可用于区分血液透析患者和健康对照者，准确率分别为76.9%和67.6%。
本研究揭示了血液透析患者的白质损伤。这种损伤发生在纤维束的特定节段，尤其是左侧丘脑辐射和左侧扣带束，这可能成为ESRD和认知障碍患者的一种新的生物标志物。
