终末期肾病合并继发性甲旁亢患者脑白质损伤的初步研究

Preliminary study on white matter injury in ending-stage renal disease patients with secondary hyperparathyroidism

目的:初步探讨终末期肾病(ESRD)合并继发性甲旁亢(SHPT)患者的脑白质微结构改变和认知功能障碍。方法:选取2015年5月—2016年6月在安徽医科大学第二附属医院肾内科确诊为ESRD合并SHPT的住院患者20例为SHPT组,招募年龄、性别、受教育程度相匹配的健康对照人群20例为健康对照组,收集所有受试者的3TMR矢状面结构图像、弥散张量图像、简易精神状态检查(MMSE)和蒙特利尔认知能力评估量表(MOCA)评分以及SHPT患者的甲状旁腺激素(PTH)数据。使用FMRIB Software Library(FSL)软件分析图像数据。结果:ESRD合并SHPT患者的脑白质各向异性分数(FA)显著降低,平均弥散率(MD)和径向弥散率(RD)增加,并表现出明显的认知功能减低。结论:ESRD合并SHPT患者认知功能受损,脑白质损伤呈广泛、对称性分布,轴突损伤与脱髓鞘损伤程度相仿。

Objective To investigate the white matter microstructural and cognitive damage of ending-stage renal disease(ESRD)patients with secondary hyperparathyroidism(SHPT).Methods 20 hospitalized patients diagnosed with ESRD combined with SHPT in the Department of Nephrology at the Second Affiliated Hospital of Anhui Medical University from May 2015 to June 2016 were selected as the SHPT group.20 healthy control individuals matched in age,gender,and education level were recruited as the healthy control group.3T MR sagittal structure images,diffusion tensor images,the Mini-Mental State Examination(MMSE)and the Montreal Cognitive Assessment(MOCA)scores for all subjects and parathyroid hormone(PTH)data of SHPT patients were collected.Image data was analyzed by using FMRIB Software Library(FSL)software.Results Anisotropy(FA)decreased significantly in ESRD patients with SHPT,mean diffusivity(MD)and radial diffusivity(RD)increased,and cognitive function decreased significantly.Conclusion The cognitive function of ESRD patients with SHPT is impaired,the white matter injury is widely and symmetrically distributed,and the degree of axon injury is similar to demyelination.