Wu Yunfan, Li Rujin, Jiang Guihua, Yang Ning, Liu Mengchen, Chen Yanying, Chen Zichao, Yu Kanghui, Yin Yi, Xu Shoujun, Xia Bin, Meng Shandong
Department of Medical Imaging, The Affiliated Guangdong Second Provincial General Hospital of Jinan University, Guangzhou, China.
The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China.
Front Neurol. 2025 Feb 18;16:1510321. doi: 10.3389/fneur.2025.1510321. eCollection 2025.
Compared with the general population, patients with end-stage renal disease (ESRD) undergoing maintenance hemodialysis (ESHD) exhibit a higher incidence of cognitive impairment. Early identification of cognitive impairment in these patients is crucial for reducing disability and mortality rates. Examining the characteristics of static and dynamic regional spontaneous activities in ESHD cases may provide insights into neuropathological damage in these patients.
Resting-state functional magnetic resonance images were acquired from 40 patients with early ESHD (3 or 4 times/week for more than 30 days but less than 12 months) and 31 healthy matched controls. Group differences in regional static and dynamic regional homogeneity (ReHo) were identified, and correlations examined with clinical variables, including neuropsychological scale scores, while controlling for covariates. Receiving operating characteristic (ROC) curve analyses were conducted to assess the accuracy of ReHo abnormalities for predicting cognitive decline among early ESHD.
The ESHD group exhibited significantly reduced static and dynamic ReHo in the temporal and parietal lobes, including regions involved in basal ganglia-thalamus-cortex circuits, the default mode network, and ventral attentional network. Several static and dynamic ReHo abnormalities (including those in the right parietal and left middle temporal gyrus) were significantly correlated with neurocognitive scale scores. In addition, the dynamic ReHo value of the left superior temporal gyrus was positively correlated with depression scale scores. Comparing the ROC curve area revealed that numerous brain regions with altered ReHo can effectively distinguish between patients with ESHD and those without cognitive impairment.
Our study found that spontaneous activity alterations located in the basal ganglia-thalamus-cortex circuit, default mode network, and ventral attentional network are associated with the severity of cognitive deficits and negative emotion in early ESHD patients. These findings provide further insight into the relationship between cognitive impairment and underlying neuropathophysiological mechanisms underlying the interplay between the kidneys and the nervous system in ESRD patients, and provide further possibilities for developing effective clinical intervention measures.
与普通人群相比，接受维持性血液透析（ESHD）的终末期肾病（ESRD）患者认知障碍的发生率更高。早期识别这些患者的认知障碍对于降低残疾率和死亡率至关重要。研究ESHD患者静息态和动态区域自发活动的特征可能有助于深入了解这些患者的神经病理损伤。
对40例早期ESHD患者（每周透析3或4次，持续超过30天但少于12个月）和31名健康匹配对照者进行静息态功能磁共振成像检查。确定区域静息态和动态区域同质性（ReHo）的组间差异，并在控制协变量的同时，检查其与包括神经心理量表评分在内的临床变量的相关性。进行接受者操作特征（ROC）曲线分析，以评估ReHo异常对预测早期ESHD患者认知衰退的准确性。
ESHD组在颞叶和顶叶的静息态和动态ReHo显著降低，包括涉及基底神经节 - 丘脑 - 皮质回路、默认模式网络和腹侧注意网络的区域。一些静息态和动态ReHo异常（包括右侧顶叶和左侧颞中回的异常）与神经认知量表评分显著相关。此外，左侧颞上回的动态ReHo值与抑郁量表评分呈正相关。比较ROC曲线面积发现，许多ReHo改变的脑区能够有效区分ESHD患者和无认知障碍者。
我们的研究发现，位于基底神经节 - 丘脑 - 皮质回路、默认模式网络和腹侧注意网络的自发活动改变与早期ESHD患者认知缺陷的严重程度和负面情绪有关。这些发现进一步深入了解了认知障碍与ESRD患者肾脏和神经系统相互作用背后的潜在神经病理生理机制之间的关系，并为制定有效的临床干预措施提供了更多可能性。
