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维持性血液透析伴 认知功能障碍患者 脑MRI影像学特点分 析

作者:鲁 冰 任东升

所属单位:河南省南阳市中心医院肾病风湿免 疫科 (河南 南阳 473000)

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摘要

目的 研究维持性血液透析(MHD) 伴认知功能障碍患者脑磁共振(MRI)影像 学特点。方法 将我院2016年1月-2018年1 月间收治的31例MHD伴认知障碍患者纳为 观察组,同时纳入50例健康体检者为对照 组,分析两组脑MRI弥散张量成像(DTI)扫 描影像学特点。结果 观察组双侧额叶、 双侧颞叶、双侧叶顶、双侧枕叶、双侧海 马、双侧内囊前肢、双侧内囊后肢等感兴 趣区域FA值均低于对照组,其中双侧额 叶及双侧海马FA值差异显著(P<0.05); 观察组左侧额叶FA值显著低于对照组 (P<0.05)、右侧海马FA值显著低于对照组 (P<0.05)。结论 MHD认知障碍者左侧额叶 及右海马FA值显著低于常模,其左侧额叶 及右侧海马易受到损坏,脑白质神经纤维 束完整性差。

Objective To study the of imaging features of brain magnetic resonance imaging (MRI) in patients with maintenance hemodialysis (MHD) and cognitive dysfunction. Methods 31 cases of patients with MHD and cognitive dysfunction admitted to our hospital from January 2016 to January 2018 were enrolled in observation group, and another 50 healthy examiners were included in control group. The scanning imaging features of brain MRI cranial diffusion tensor imaging (DTI) were analyzed in the two groups. Results The FA values of regions of interest of bilateral frontal lobe, bilateral temporal lobe, bilateral apical lobe, bilateral occipital lobe, bilateral hippocampus, bilateral internal capsule forelimb and bilateral internal capsule hind limb in observation group were lower than those in control group, and the FA value of bilateral frontal lobe and bilateral hippocampus was significantly different (P<0.05). The FA value of left frontal lobe in observation group was significantly lower than that in control group (P<0.05). The FA value of right hippocampus was significantly lower than that in control group (P<0.05). Conclusion The FA values of left frontal lobe and right hippocampus of patients with MHD and cognitive dysfunction are significantly lower than those in normal model, and its left frontal lobe and right hippocampus are vulnerable to damage, and the nerve fiber bundle of white matter is with poor integrity.

【关键词】维持血液透析;认知功能障碍 者;脑MRI影像学特点

【中图分类号】R692.5;R445.2

【文献标识码】A

【DOI】 10.3969/j.issn.1672- 5131.2019.04.006

前言

维持血液透析(maintenance hemodialysis,MHD)已成为终末期肾 病(end-stage renal disease,ESRD)患者维持生命的主要的治疗方 式,而由于长时间MHD治疗所导致的低灌注量将引起急性脑缺血,诱 发认知功能障碍[1]。关注MHD患者认知功能,及早发现并纠正其认知问 题,是提高患者生活质量,改善其预后效果的有效保障[2]。有研究发 现,脑白质损伤程度与患者认知功能障碍呈正相关,有效监测患者脑 白质状态,在筛查MHD认知障碍患者中具有积极意义,脑MRI颅弥散张 量成像(diffusion tensor imagingDTI)能有效显示组织内水分子弥 散的各向异性特征,方便诊断者通过观察各向异性分数(fractional anisotropy,FA)判断白质纤维束的完整性,在痴呆等认知障碍性脑损 伤疾病中具有良好的应用价值[3]。为研究DTI成像在MHD认知功能障碍者 中的应用效果,我院开展如下研究。