基于磁共振成像的终末期肾病伴认知障碍患者脑内血管周围间隙研究

An MRI study of cerebral perivascular space in patients with end-stage renal disease comorbid cognitive impairment

摘要

目的 探讨终末期肾病(end-stage renal disease, ESRD)伴认知障碍(cognitive impairment, CI)患者脑内血管周围间隙(perivascular space, PVS)的变化及其与认知损伤的关系。方法 纳入65例ESRD伴CI患者(ESRD组)和年龄、性别相匹配的54名健康志愿者(对照组),采用蒙特利尔认知评估量表(Montreal Cognitive Assessment, MoCA)、听觉词语学习测验-华山版(Auditory Verbal Learning Test-Huashan Version, AVLT-H)评估所有被试的认知功能。采集所有被试的3D-T1WI数据,应用自动化PVS体积分析方法计算ESRD组和对照组全脑、白质、基底节区及海马的PVS体积分数(PVS volume fraction, PVSVF)。采用非参数检验对2组被试的认知功能评分及PVSVF进行组间比较,对存在组间差异的PVSVF与认知评分进行偏相关性分析,并依据PVSVF大小进行分层分析。结果 与对照组相比,ESRD组MoCA评分、即时回忆评分、短时延迟回忆评分、长时延迟回忆评分、再认评分均显著降低(P均＜0.05);ESRD组的全脑、白质和基底节区PVSVF均显著大于对照组(P均＜0.05)。在控制了年龄、性别和受教育年限后,ESRD组基底节区PVSVF与MoCA评分、即时回忆评分、短时延迟回忆评分、长时延迟回忆评分及再认评分均呈负相关(r值在-0.29至-0.36之间)。分层分析显示,在基底节区PVSVF较大的ESRD亚组中,基底节区PVSVF与MoCA评分、短时延迟回忆评分、长时延迟回忆评分、再认评分呈负相关(r值在-0.38至-0.47之间)。结论 ESRD伴CI患者全脑及多个脑区的PVSVF增大,其中增大更明显的基底节区PVSVF可能在其产生CI过程中起重要作用。

Abstract

Objective To investigate alterations in cerebral perivascular space (PVS) and their association with cognitive deficits in patients with end-stage renal disease (ESRD) and comorbid cognitive impairment (CI). Methods A total of 65 ESRD patients with CI (ESRD group) and 54 age- and sex-matched healthy volunteers (control group) were enrolled. Montreal Cognitive Assessment (MoCA) and the Auditory Verbal Learning Test-Huashan Version (AVLT-H) were performed on each participant to evaluate their cognitive function. Three-dimensional T1-weighted imaging data were acquired. An automated perivascular space (PVS) volumetric analysis method was implemented to calculate PVS volume fraction (PVSVF) in the whole brain, white matter, basal ganglia, and hippocampus for both groups. Non-parametric test (Mann-Whitney U) was performed for inter-group comparison. Partial correlation analyses were then made between PVSVF values in regions showing group differences and cognitive scale scores. Finally, stratified analyses were conducted based on PVSVF values. Results Compared with the control group, the ESRD group showed significantly decreased scores in MoCA, immediate recall, short-delayed recall, long-delayed recall, and recognitions (all P＜0.05). Additionally, significantly higher PVSVF in the whole brain, white matter and basal ganglia were observed in the ESRD group (all P＜0.05). After controlling for age, sex, and education duration, the basal ganglia PVSVF in the ESRD group showed negative correlations with MoCA scores, immediate recall scores, short-delay recall scores, long-delay recall scores, and recognition scores (r-values ranging from -0.29 to -0.36). Stratified analysis revealed that in the ESRD subgroup with larger basal ganglia PVSVF, basal ganglia PVSVF was negatively correlated with MoCA scores, short-term delayed recall scores, long-term delayed recall scores, and recognition scores (r values ranging from -0.38 to -0.47). Conclusion Increased PVSVF in the whole brain and multiple brain regions was found in ESRD patients with CI. Notably, a greater magnitude of PVSVF in the basal ganglia may play an important role in the pathogenesis of CI in this population.

关键词

磁共振成像(MRI) / 终末期肾病(ESRD) / 认知障碍(CI) / 血管周围间隙体积分数(PVSVF)

Key words

magnetic resonance imaging (MRI) / end-stage renal disease (ESRD) / cognitive impairment (CI) / perivascular space volume fraction (PVSVF)

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基金资助

陕西省卫生健康脑科学与影像新技术科研创新平台(2023PT-09)

西安交通大学第一附属医院临床研究课题(XJTU1AF-CRF-2023-021)