终末期肾病维持性血液透析患者神经血管耦合功能的MRI研究

MRI study on neurovascular coupling in patients with maintenance hemodialysis of end-stage renal disease

目的:分析终末期肾病(ESRD)维持性血液透析(MHD)患者神经血管耦合(NVC)功能的变化,探究这种变化与MHD患者认知功能障碍之间的关系,及其在认知功能障碍中发生的神经生理病理机制。方法:将29例MHD患者和29例年龄、性别相匹配的健康志愿者(HC组)纳入本研究。搜集MHD组患者的人口学资料及临床资料(血红蛋白,血肌酐、血尿素氮、血钙、透析时长)。所有受试者接受神经心理学测试(蒙特利尔认知评估量表,MoCA),随后行静息态脑功能成像(rs-fMRI)及三维伪连续性动脉自旋标记(3D-pCASL)MRI检查,分别获得低频振荡振幅(ALFF)及脑血流量(CBF)图,计算灰质模板内CBF与ALFF的比值,即得到神经血管耦合(NVC)图;提取组间差异显著脑区的NVC值,并与MHD患者的临床资料和神经心理学测试结果进行相关性分析。结果:与HC组相比,MHD患者双侧海马、双侧颞下回、双侧豆状壳核、左侧梭状回、右侧海马旁回、右侧内侧和旁扣带回以及右侧尾状核的NVC值减低(P<0.05,FDR校正)。左侧颞下回和右侧海马旁回的NVC值与视空间和执行功能呈负相关(P<0.05);右侧豆状壳核的NVC值与语言功能呈正相关(P<0.05);左侧海马和左侧梭状回的NVC值与血肌酐水平呈正相关,与透析时长呈负相关(P均<0.05);右侧尾状核的NVC值与透析时长呈负相关(P<0.05)。结论:终末期肾病维持性血液透析患者NVC的改变与认知功能损害相关;NVC通过不同神经血管调控通路调节MHD患者的认知功能。此外透析时长、血肌酐水平可能导致大脑内稳态失衡,造成NVC功能受损,进而导致认知功能障碍。

Objective:To explore the changes in neurovascular coupling(NVC)function in patients with end-stage renal disease(ESRD)maintenance hemodialysis(MHD),and to discuss the relationship between such changes and cognitive dysfunction in MHD patients,and the neurophysiological and pathological mechanisms occurring in cognitive dysfunction.Methods:Twenty-nine MHD patients and 29 age-and sex-matched normal controls(HC)were collected.All subjects underwent neuropsychological testing(Montreal Cognitive Assessment Scale,MoCA).Demographic data and clinical data of the MHD group(hemoglobin,blood creatinine,blood urea nitrogen,blood calcium,and dialysis duration)were collected,followed by resting-state functional MRI(rs-fMRI)and three-dimensional pseudo-continuous arterial spin labeling(3D-pCASL-MRI).Amplitude of frequency fluctuation(ALFF)and cerebral blood flow(CBF)map were obtained respectively,and the CBF to ALFF ratio in the gray matter template was calculated,and the NVC map was obtained.The NVC results of significantly different brain regions were extracted,and the correlation was analyzed with MHD patients,dialysis duration and neuropsychological test results.Results:Compared with MHD controls,bilateral hippocampus,bilateral inferior temporal gyrus,bilateral putamen,left fusiform gyrus,right parahip-pocampal gyrus,right medial and collateral cingulate gyrus,and right caudate nucleus,NVC were decreased in MHD patients(P<0.05,FDR correction).The NVC of the left inferior temporal gyrus and right parahippocampal gyrus were negatively correlated with visual space and executive ability;the right putamen NVC was positively correlated with language function;the left hippocampus and left NVC were positively associated with blood creatinine content and dialysis duration;and the right caudate NVC was negatively correlated with dialysis length(P<0.05).Conclusion:The NVC changes in maintenance hemodialysis patients are associated with cognitive impairment;NVC regulates cognitive function in MHD patients through different neurovascular regulation pathways.In addition,dialysis duration and blood creatinine content may lead to an imbalance in homeostasis in the brain,causing impaired NVC function,and thus cognitive dysfunction.