慢性肾脏病患者的认知障碍与脑白质损伤磁共振弥散张量成像研究

Diffusion tensor imaging of white matter injury and cognitive impairment in patients with chronic kidney disease

目的探讨慢性肾脏病患者肾功能下降与认知障碍及脑白质损伤的关系。方法选取30例慢性肾脏病(CKD2-5期)患者和30例肾功能正常者,接受磁共振(magnetic resonance imaging,MRI)弥散张量成像(diffusion tensor imaging,DTI)检查,同时进行蒙特利尔认知评估量表(MoCA)测试。采用SPSS26.0统计软件对数据进行分析。结果CKD组较肾功能正常组双侧额叶,双侧顶叶各向异性分数(fractional anisotropy,FA)值减低,双侧额叶,左侧颞叶,左侧顶叶表观弥散系数(apparent diffusion coefficient,ADC)值升高,患者的MoCA评分随eGFR值的下降而下降。eGFR值与左侧额叶,右侧额叶,左侧颞叶,右侧顶叶FA值,左侧额叶,右侧颞叶,左侧顶叶ADC值存在显著相关性。MocA评分与左侧额叶,左侧颞叶,右侧顶叶FA值,左侧额叶,右侧颞叶ADC值存在显著相关性,差异有统计学意义(P<0.05).结论患者的肾功能下降与认知功能损害及脑白质损害具有相关性。肾功能下降可能是患者脑白质病变及认知功能下降的独立危险因素。

Objective To investigate the relationship between renal decline and cognitive impairment and white matter injury in patients with chronic kidney disease(CKD).Methods 30 patients with chronic kidney disease(CKD2-5)and 30 patients with normal renal function were selected and underwent diffusion tensor imaging(DTI)and Montreal cognitive assessment Scale(MoCA)test.SPSS26.0 statistical software was used to analyze the data.Results Fractional anisotropy(FA)value of bilateral frontal lobe and bilateral parietal lobe in CKD group is lower than that of normal renal function group.Apparent diffusion coefficient(ADC)of bilateral frontal lobe,left temporal lobe and left parietal lobe increased in CKD group.The MocA score of patients decreased with the decrease of eGFR.eGFR values were significantly correlated with FA values of the left frontal lobe,right frontal lobe,and ADC values of left temporal lobe,right parietal lobe,left frontal lobe,right temporal lobe,and left parietal.MocA score was significantly correlated with FA values of left frontal lobe,left temporal lobe,right parietal lobe,and ADC values of left frontal lobe,right temporal lobe.The difference was statistically significant(P<0.05).Conclusion The decline of renal function is correlated with cognitive impairment and white matter impairment.Renal function decline may be an independent risk factor for leukoencephalopathy and cognitive decline.