Ko Junghae, Park Bong Soo, Heo Chang Min, Yi Jiyae, Lee Dong Ah, Park Kang Min
Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea.
Department of Neurology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea.
Front Neurol. 2024 Sep 20;15:1480536. doi: 10.3389/fneur.2024.1480536. eCollection 2024.
Studies have recently shown an alteration of the structural connectivity and a dysfunctional glymphatic system in patients with chronic kidney disease (CKD). In this study, we aimed to investigate the effects of the structural connectivity and glymphatic system on the cognitive function of patients with CKD.
We prospectively enrolled patients with CKD and healthy controls. The CKD group was divided into two regarding their cognitive function. All patients received brain magnetic resonance imaging, including diffusion tensor imaging (DTI). We calculated the measures of structural connectivity and diffusion tensor image analysis along the perivascular space (DTI-ALPS) index, a neuroimaging marker of the glymphatic system function, and compared the indices between groups.
The mean clustering coefficient, local efficiency, and small-worldness index in patients with CKD were lower than those in healthy controls (0.125 ± 0.056 vs. 0.167 ± 0.082, = 0.008; 1.191 ± 0.183 vs. 1.525 ± 0.651, = 0.002; 0.090 ± 0.043 vs. 0.143 ± 0.102, = 0.003; respectively). The DTI-ALPS index was lower in patients with CKD than in healthy controls (1.436 vs. 1.632, < 0.001). Additionally, the DTI-ALPS index differed significantly between CKD patients with and without cognitive impairment. Notably, this index was lower in patients with CKD and cognitive impairment than in patients without cognitive impairment (1.338 vs. 1.494, = 0.031). However, there were no differences of the structural connectivity between CKD patients with and without cognitive impairment.
We found lower DTI-ALPS index in patients with CKD, which could be related with glymphatic system dysfunction. Moreover, those with cognitive impairment in the CKD group had a lower index than those without, indicating a link between the glymphatic system function and cognitive function.
近期研究显示，慢性肾脏病（CKD）患者存在结构连接性改变及类淋巴系统功能障碍。在本研究中，我们旨在探究结构连接性和类淋巴系统对CKD患者认知功能的影响。
我们前瞻性纳入了CKD患者和健康对照者。CKD组根据认知功能分为两组。所有患者均接受了脑磁共振成像检查，包括扩散张量成像（DTI）。我们计算了结构连接性指标以及沿血管周围间隙的扩散张量图像分析（DTI-ALPS）指数（类淋巴系统功能的一种神经影像学标志物），并比较了各组之间的指数。
CKD患者的平均聚类系数、局部效率和小世界指数均低于健康对照者（分别为0.125±0.056对0.167±0.082，P = 0.008；1.191±0.183对1.525±0.651，P = 0.002；0.090±0.043对0.143±0.102，P = 0.003）。CKD患者的DTI-ALPS指数低于健康对照者（1.436对1.632，P < 0.001）。此外，有和没有认知障碍的CKD患者之间DTI-ALPS指数存在显著差异。值得注意的是，有认知障碍的CKD患者该指数低于无认知障碍的患者（1.338对1.494，P = 0.031）。然而，有和没有认知障碍的CKD患者之间结构连接性并无差异。
我们发现CKD患者的DTI-ALPS指数较低，这可能与类淋巴系统功能障碍有关。此外，CKD组中有认知障碍者的指数低于无认知障碍者，表明类淋巴系统功能与认知功能之间存在联系。
