静息态fMRI观察终末期肾病患者执行功能障碍相关自发脑活动异常

目的 采用静息态fMRI（rs-fMRI）及低频振荡振幅（ALFF）算法探讨终末期肾病（ESRD）患者执行功能障碍相关的自发脑活动异常。方法 收集35例ESRD患者（ESRD组）和32名性别、年龄匹配的健康志愿者（对照组），对其行连线测试（TMT）评估及rs-fMRI；采集ESRD组患者实验室检查指标，包括血清肌酐、血红蛋白、尿素和胱抑素C。采用SPM8及REST l.8软件，获得2组平均ALFF图；提取2组间ALFF差异有统计学意义的脑区，以Pearson相关性分析评价差异脑区的平均ALFF值与TMT评分及实验室检查指标的相关性。结果 与对照组比较，ESRD组患者双侧额中回、双侧楔前叶、双侧额内侧回、双侧扣带回、双侧颞中回、左侧枕中回及右侧额上回平均ALFF值减低（P均<0.001，FDR校正），无平均ALFF值增高脑区。ESRD组左侧额中回（r=-0.57，P<0.001）及中扣带回（r=-0.55，P<0.001）平均ALFF值与TMT评分呈负相关。ESRD组前扣带回（r=0.63，P<0.001）、左侧额中回（r=0.64，P<0.001）及左侧颞中回（r=0.51，P<0.001）平均ALFF值与血红蛋白水平呈正相关。差异脑区平均ALFF值与ESRD组血肌酐、尿素、胱抑素C水平均无明显相关（P均>0.05）。结论 ESRD患者左侧额中回及中扣带回自发脑功能异常与执行功能障碍密切相关，左侧额中回自发脑活动异常与贫血密切相关，有望成为评估ESRD患者执行功能障碍及治疗监测的影像学标记。

Resting-state fMRI observation of abnormal spontaneous brain activity related to executive dysfunction in patients with end-stage renal disease

Objective To investigate the executive dysfunction and related abnormal spontaneous brain activity in patients with end-stage renal disease (ESRD) using resting-state fMRI (rs-fMRI) and amplitude of low-frequency fluctuation (ALFF) algorithm. Methods Totally 35 ESRD patients (ESRD group) and 32 healthy controls (control group) with matched sex and age were assessed with trail making test (TMT) and rs-fMRI. The blood tests, include creatinine, hemoglobin, urea and cystatin C were collected in all ESRD patients. SPM8 and REST 1.8 software were used to process the data and generate mean ALFF maps in all participants, and the brain regions with different ALFF were obtained. In addition, the correlation between the mean ALFF values of significant brain regions and TMT scores, as well as blood tests 1evels were evaluated with Pearson correlation analysis. Results Compared with control group, the brain regions in ESRD group with significantly decreased mean ALFF values included the bilateral middle frontal gyrus, bilateral precuneus, bilateral medial frontal gyrus, bilateral cingulate gyrus, bilateral middle temporal gyrus, left middle occipital gyrus and right superior frontal gyrus (all P<0.001, FDR corrected). TMT score of ESRD group was negatively correlated with mean ALFF values in the left middle frontal gyrus (r=-0.57, P<0.001) and middle cingulate gyrus (r=-0.55, P<0.001). The level of hemoglobin was positively correlated with mean ALFF values in anterior cingulate gyrus (r=0.63,P<0.001), left middle frontal gyrus (r=0.64, P<0.001) and left middle temporal gyrus (r=0.51, P<0.001). The levels of creatinine, urea and cystatin C showed no significant correlation with mean ALFF values (all P>0.05). Conclusion Executive dysfunction is closely correlated with the abnormal spontaneous brain activity in left middle frontal gyrus and middle cingulate gyrus in ESRD patients, and the levels of hemoglobin were correlated with the abnormal spontaneous brain activity in left middle frontal gyrus, which may provide a novel imaging marker for executive dysfunction and intervention in ESRD patients.