无认知功能障碍的终末期肾病患者全脑皮质厚度变化研究

摘要

Objective To investigate the changes of cerebral cortical thickness in patients with endstage renal disease (ESRD) and the relationship between cortical thickness and kidney function.Methods A total of 35 ESRD patients were enrolled in this study.Systolic blood pressure (SBP),diastolic blood pressure (DBP),hemoglobin (Hb),serum creatinine (Cr),blood urea nitrogen (BUN),total cholesterol (TC),serum potassium and serum calcium of those patients were examined.Head MRI was performed to observe the changes of cerebral cortical thickness.Pearson correlation analysis was used to explore the relationship between cerebral cortical thickness and kidney function.Results Compared with normal controls,ESRD patients showed decreased cerebral cortical thickness in right prefrontal cortex,including lateral prefrontal cortex (Peak 1 and 2),medial prefrontal cortex (Peak 3) and ventral prefrontal cortex (Peak 4;P ＜ 0.05,for all,RFT correction).Pearson correlation analysis showed that lateral prefrontal cortex thickness (Peak 1:r =-0.344,P =0.043;Peak 2:r =-0.335,P =0.049) and medial prefrontal cortex thickness (Peak 3:r =-0.387,P =0.021) were negatively correlated with serum Cr;lateral prefrontal cortex thickness (Peak 1:r =-0.384,P =0.023;Peak 2:r =-0.380,P =0.024),medial prefrontal cortex thickness (Peak 3:r =-0.470,P =0.004)and ventral prefrontal cortex thickness (Peak 4:r =-0.440,P =0.009) were negatively correlated with serum BUN:medial prefrontal cortex thickness (Peak 3) was positively correlated with Hh (r =0.339,P =0.046)and was negatively correlated with serum potassium (r =-0.335,P =0.049);lateral prefrontal cortex thickness (Peak 2) was positively correlated with corrected serum calcium (r =0.354,P =0.037).Conclusions ESRD patients had decreased thickness of right prefrontal cortex,including lateral prefrontal cortex,medial prefrontal cortex and ventral prefrontal cortex,which was correlated with kidney function.These results provided compelling evidence for cortical abnormality of ESRD patients,and suggested that kidney function may be the key factor for predicting changes of brain tissue structure.%目的 观察终末期肾病患者大脑皮质厚度变化,并探讨其与肾功能的相关性.方法 共35例终末期肾病患者,测量收缩压、舒张压、血红蛋白、血清肌酐、尿素氮、总胆固醇、血清钾和血清钙,并行头部MRI检查,观察大脑皮质厚度变化,Pearson相关分析探讨其与肾功能的相关性.结果 与正常对照者相比,终末期肾病患者右侧前额叶皮质[包括4个局部峰值顶点,即外侧前额叶皮质(峰值1和2)、内侧前额叶皮质(峰值3)和腹侧前额叶皮质(峰值4)]厚度减少(均P＜ 0.05,RFT校正).Pearson 相关分析显示,终末期肾病患者外侧前额叶皮质厚度(峰值1:r =-0.344,P=0.043;峰值2:r=-0.335,P=0.049)和内侧前额叶皮质厚度(峰值3:r=-0.387,P=0.021)与血清肌酐呈负相关;外侧前额叶皮质厚度(峰值1:r=-0.384,P=0.023;峰值2:r=-0.380,P=0.024)、内侧前额叶皮质厚度(峰值3:r=-0.470,P=0.004)和腹侧前额叶皮质厚度(峰值4:r=-0.440,P=0.009)与血清尿素氮呈负相关;内侧前额叶皮质厚度(峰值3)与血红蛋白呈正相关(r =0.339,P=0.046),与血清钾呈负相关(r=-0.335,P=0.049);外侧前额叶皮质厚度(峰值2)与校正血清钙呈正相关(r=0.354,P=0.037).结论 终末期肾病患者右侧前额叶皮质(包括外侧前额叶皮质、内侧前额叶皮质和腹侧前额叶皮质)厚度减少,且与肾功能具有一定相关性,为终末期肾病患者灰质形态学异常提供有力证据,同时也表明肾功能可能是预测脑结构改变的关键因素.