维持性血液透析患者脑体积变化及其与睡眠质量、焦虑及抑郁的相关性

目的 采用基于体素的形态学测量（VBM）法观察终末期肾病（ESRD）维持性血液透析患者脑体积变化及其与睡眠质量、抑郁及焦虑的相关性。方法 对20例ESRD维持性血液透析患者（病例组）和21名健康志愿者（正常对照组）行MR扫描及神经心理学量表测评，包括蒙特利尔认知评估量表（MoCA）、匹兹堡睡眠质量指数量表（PSQI）、焦虑自评量表（SAS）与抑郁自评量表（SDS）。比较2组间脑体积变化，分析病例组脑体积变化区域与神经心理学测量评分的相关性。结果 与正常对照组相比，病例组左侧颞中回、右侧额中回及左内侧额上回的脑灰质体积减小（P均<0.001，AlphaSim多重校正后）；2组间MoCA、PSQI、SAS及SDS评分差异均具有统计学意义（P均<0.05）。病例组左侧颞中回体积减小分别与PSQI、SDS及SAS评分呈负相关（r=-0.588、-0.456、-0.489，P=0.006、0.043、0.029）；右侧额中回体积减小分别与SDS及SAS评分呈负相关（r=-0.495、-0.466，P=0.026、0.038）；左内侧额上回体积减小分别与MoCA评分呈正相关（r=0.462，P=0.040），与PSQI评分呈负相关（r=-0.588，P=0.006）。结论 ESRD维持性血液透析患者部分脑灰质体积萎缩，并有认知功能下降；伴睡眠质量差、焦虑或抑郁者可能与相应脑灰质体积减少有关。

Brain volume changes in patients with maintaining hemodialysis and the correlation with sleep quality, anxiety and depression

Objective To investigate the changes of cerebral volume in end stage renal disease (ESRD) patients with maintaining hemodialysis using voxel-based morphometry (VBM), and to observe the correlation of these changes with sleep quality, anxiety and depression. Methods Twenty ESRD patients received maintaining hemodialysis (patient group) and twenty-one normal volunteers (normal control group) underwent MRI and neuropsychological scale evaluations, including the Montreal Cognitive Assessment Scale (MoCA), Pittsburgh Sleep Quality Index Scale (PSQI), Self-rating Anxiety Scale (SAS) and Self-rating Depression Scale (SDS). The changes of cerebral volume between the two groups were compared, and the correlation between the changed area of cerebral volume in patient group and the score of neuropsychological scale was analyzed. Results Compared with normal control group, significantly decreased volume in the gray matter of the left middle temporal gyrus, right middle frontal gyrus and left medial frontal gyrus were observed in patient group (all P<0.001, AlphaSim multiple corrections). The differences of MoCA, PSQI, SAS and SDS between the two groups were statistically significant (all P<0.05). In patient group, the decreased gray matter volume of the left middle temporal gyrus negativity correlated with PSQI, SDS and SAS (r=-0.588, -0.456, -0.489; P=0.006, 0.043, 0.029), of the right middle frontal gyrus negativity correlated with SDS and SAS (r=-0.495, -0.466; P=0.026, 0.038), of the left medial frontal gyrus positively correlated with MoCA (r=0.462, P=0.040), and negatively correlated with PSQI (r=-0.588, P=0.006). Conclusion Multiple grey matter atrophy and complicated neurocognitive dysfunction were noticed in ESRD patients with maintaining hemodialysis, and the associated poorer sleep quality, anxiety or depression severity might closely related to the decreased volume of corresponding brain gray matter.