维持性透析患者脑白质弥散功能成像及与认知功能的相关性研究

3.0T MRI Diffusion Functional Imaging in White Matter of Maintenance Dialysis Patients and Its Correlation with Cognitive Function

目的研究维持性透析患者脑白质弥散功能成像与认知功能的相关性。方法 63例终末期肾病(ESRD)患者作为研究组,28例健康体检者作为对照组,分别进行常规MR、DWI、DTI检查,测量感兴趣区(额叶、颞叶、顶叶、枕叶、内囊、胼胝体及海马等)脑白质的表观扩散系数(ADC)及各向异性分数(FA),所有研究对象均采用中文版蒙特利尔认知评估量表评分(C-MoCA)并按评分分三个级别,即正常(C-MoCA≥26分),轻度认知功能障碍(26分>C-MoCA≥21分),重度认知功能障碍(21分>C-MoCA),与对照组及各级别之间进行统计学比较。最后采用Pearson相关分析法分析有统计学差异区域的ADC、FA值与C-MoCA评分的相关性。结果 63例维持性透析患者中23例认知功能在正常范围,28例属于轻度认知功能障碍,12例重度认知障碍。研究组额叶、顶叶脑白质ADC及FA值与对照组均存在统计学差异(P<0.05),C-MoCA不同分级的脑白质ADC及FA值之间亦存在统计学差异(P<0.05)。研究组额叶、顶枕叶脑白质ADC值与C-MoCA呈负相关,FA值与C-MoCA呈正相关。结论维持性透析患者脑白质弥散功能成像可定量评价ESRD脑白质病变且与C-MoCA密切相关,有助于ESRD患者认知功能障碍的检出。

Objective To investigate the correlation between 3.0T MRI diffusion functional imaging in white matter and cognitive fimction in maintenance dialysis patients. Methods A total of 63 cases of end-stage renal disease （ESP, D） patients as study gronp, 28 cases of healthy persons as control group, all received conventional MR, DWI and DTI examination. DWI and DT1 were used to quantify, the apparent diffusion coefficient （ADC） and the fractional anisotropy（FA） of white matter m the frontal lobe, temporal lobe, parietal lobe, occipital lobe, internal capsule, corpus callosum, and the bippocampus. All the research object using the Chinese version of the Montreal cognitive assessment scale score （C-MoCA）, namely normal （C-MoCA≥26 points）, lnild cognitive dysfunction （26 points 〉C-MoCA ≥21 points）, severe cognitive dysfimction （21 points 〉C-MoCA）, control group and the levels between pairwise statistical comparisons were performed. Pearson correlation coefficients were calculated to quantify statistically significant areas of ADC and FA values and the correlation of C-MoCA score.Results Of the 63 patients undergoing maintenance dialysis, 23 had normal cognitive function, 28 cases belonged to mild cognitive impairment, 12 cases with severe cognitive impairment. The ADC and FA values of frontal lobe, parietal lobe and white matter in the study group were statistically different from those in the control group, between the levels of C-MoCA ADC and FA values also exist statistical difference （P〈0.（15）. The ADC values of the frontal lobe and parietal lobe of the study group were negatively correlated with the C-MoCA score. The FA values of the frontal lobe and parietal lobe of the study group were positively correlated with the the C-MoCA score. Conclusion Diffusion functional imaging can be quantitatively, sensitively reflected the characteristics of white matter lesions in maintenance dialysis patients and these changes are related to cognitive function. This helps the early diagnosis of cognitive impairment and improve the quality of survival in patients with ESRD.