终末期肾脏病伴不宁腿综合征患者的经颅超声改变

The changes of transcranial sonography in end-stage renal disease with restless legs syndrome

目的探讨终末期肾脏病伴不宁腿综合征患者的经颅超声(TCS)神经影像学变化特点.方法对2017年1月至2018年12月苏州大学附属第二医院诊治的终末期肾脏病伴不宁腿综合征患者(RLS+组) 41例、终末期肾脏病不伴不宁腿综合征患者(RLS -组) 57例、健康志愿者(对照组) 47例行TCS检查,对比分析其中脑黑质、中缝核及红核变化特点.结果①以黑质低回声作为阳性改变, RLS+组阳性率(36 .6%, 15/41)明显高于RLS -组(19 .3%, 11/57)及对照组(8 .5%, 4/47),差异有统计学意义(χ2 =10 .6 ,P <0 .05);②以中缝核回声减低、中断或者消失作为阳性改变, RLS+组(34 .1%, 14/41)及RLS -组(29 .8%, 17/57)阳性率明显高于对照组(10 .6%, 5/47),差异有统计学意义(χ2 =7 .7 ,P <0 .05);③以红核回声增强为阳性表现, RLS+组阳性率(51 .2%,21/41)明显高于RLS -组(21 .1%, 12/57 )及对照组(10 .6%, 5/47 ),差异有统计学意义(χ2 = 19 .8 , P <0 .05);④RLS+组及RLS -组中,有10例黑质、中缝核、红核三者均是阳性,其中7例为RLS+,诊断的准确性达70 .0%(7/10).结论通过观察黑质、中缝核、红核回声的改变特点, TCS能够为终末期肾脏病伴不宁腿综合征的临床诊治提供有价值的信息.

Objective To discuss the neuroimaging characteristics of transcranial ultrasound in end-stage renal disease (ESRD) with restless legs syndrome. Methods Transcranial sonography (TCS) was performed in ESRD with restless legs syndrome (RLS+ group, n=41), ESRD without restless legs syndrome (RLS- group, n=57) and control group (n=47), who were enrolled in the Second Affiliated Hospital of Soochow University from January 2017 to December 2018. The differences of the neuroimaging characteristics of TCS in substantia nigra (SN), brainstem raphe (BR) and red nucleus(RN) among the three groups were analyzed. Results The rate of SN hypoechogenicity was significantly higher in RLS+ group (36.6%, 15/41) than that in RLS- group (19.3%, 11/57) and control group(8.5%, 4/47)(χ2=10.6, P<0.05). The rate of abnormal BR echogenicity was significantly higher in RLS+ group (34.1%, 14/41) and RLS- group (29.8%, 17/57) than that in control group(10.6%, 5/47)(χ2=7.7, P<0.05). The rate of RN hyperechogenicity was significantly higher in RLS+ group (51.2%, 21/41) than that in RLS- group (21.1%, 12/57) and control group (10.6%, 5/47)(χ2=19.8, P<0.05). Between RLS+ and RLS- groups, when SN, BR and RN were all of positive performance, the accuracy of diagnosing RLS+ reached 70%(7/10). Conclusions The echogenicity changes of SN, BR and RN on TCS could provide valuable neuroimaging information for the clinical diagnosis and treatment of ESRD with restless legs syndrome.