慢性肾脏病与脑小血管病患者磁共振弥散张量成像的相关性研究

Correlation of chronic kidney disease with diffusion tensor imaging in patients with cerebral small vessel disease

目的：探讨慢性肾脏病（CKD）与脑小血管病（SVD）患者磁共振弥散张量成像（DTI）的关系。方法选取2012年10月至2014年5月南京医科大学附属南京医院神经内科诊治的54例SVD患者，根据肾小球滤过率（GFR）将患者分为CKD组（17例）和非CKD组（37例）。行常规磁共振成像（MRI）和DTI检查，观察感兴趣区部分各向异性（FA）及表观扩散系数（ADC）的变化，分析FA、ADC值与GFR的相关性。结果与非CKD组比较，CKD组双侧半卵圆中心、丘脑和右侧额叶FA值明显降低（ P＜0.05）；CKD组双侧半卵圆中心、右侧额叶ADC值明显升高（ P＜0.05）。Pearson相关分析示，双侧半卵圆中心及左侧丘脑FA值与GFR呈正相关（ r＝0.591， P＝0.000；r＝0.544， P＝0.000；r＝0.282， P＝0.039）；双侧半卵圆中心ADC值与GFR呈负相关（r＝-0.490，P＝0.000；r＝-0.405,P＝0.002）。结论 DTI能更敏感地发现SVD患者脑微观结构的变化，DTI与GFR有密切的关系，能为评价CKD并发SVD提供研究工具。

ObjectiveTo investigate the correlation of chronic kidney disease （CKD） with diffusion tensor imaging （DTI） in the patients with cerebral small vessel disease （SVD）.Methods A total of 54 patients with confirmed SVD according to expert consensus admitted in the Nanjing Hospital from October 2012 to May 2014 were enrolled in this study. They were divided into 2 groups based on the glomerular filtration rate （GFR）： CKD group [GFR〈60（ml/min·1.73）m2,n=17] and non-CKD group （n=37）. All of them received conventional magnetic resonance imaging （MRI） and DTI. The fractional anisotropy （FA） and apparent diffusion coefficient （ADC） values were measured in the regions of interest. The correlation of FA and ADC with GFR was analyzed.Results Compared to the non-CKD group, the CKD group had significantly lower FA values in the bilateral centrum semiovale, thalamus and right frontal lobes （P〈0.05）, and obviously higher ADC values of the bilateral centrum semiovale and the right frontal lobes （P〈0.05）. Pearson correlation analysis showed that the FA values of bilateral centrum semiovale and left thalamus were positively correlated with GFR （r=0.591,P=0.000;r=0.544,P=0.000;r=0.282,P=0.039）, and the ADC values of bilateral centrum semiovale were negatively correlated with GFR （r=-0.490,P=0.000;r=-0.405,P=0.002）.Conclusion DTI can more sensitively detect the cerebral microstructural changes in SVD patients, and is closely associated with GFR. So it can be used to evaluate CKD complicated with SVD.