| 单艳棋,徐佳佳,苏莲子,赵茹,邹立巍,王龙胜.弥散张量成像评估终末期肾病继发甲状旁腺功能亢进症患者认知及脑白质损伤[J].中国医学影像技术,2024,40(3):341~345 |
| 弥散张量成像评估终末期肾病继发甲状旁腺功能亢进症患者认知及脑白质损伤 |
| Diffusion tensor imaging for evaluation on cognitive and white matter damage in end-stage renal disease patients with secondary hyperparathyroidism |
| 投稿时间：2023-08-14 修订日期：2023-12-17 |
| DOI：10.13929/j.issn.1003-3289.2024.03.005 |
| 中文关键词: 肾功能不全,慢性 继发性甲旁亢 磁共振成像 |
| 英文关键词:renal insufficiency, chronic hyperparathyroidism, secondary magnetic resonance imaging |
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| 中文摘要: |
| 目的 采用弥散张量成像(DTI)评估终末期肾病(ESRD)继发甲状旁腺功能亢进症(SHPT)患者认知及脑白质微结构损伤。方法 回顾性分析50例ESDR患者,以其中25例SHPT者为SHPT组,以25例非SHPT者为对照组,记录其简易精神状态检查(MMSE)评估结果及相关临床血清学指标;比较颅脑DTI所示组间各向异性分数(FA)、平均弥散率(MD)、轴向弥散率(AD)及径向弥散率(RD),分析SHPT组MMSE评分及血清学指标与上述指标组间存在差异脑区DTI参数的相关性。结果 相比对照组,SHPT组MMSE评分明显减低、血清钙水平略升高(P均＜0.05);包括大脑半球、小脑及脑干的多个脑区FA及AD减低,且大脑异常以右侧为主,部分脑区RD升高。SHPT组MMSE评分与全段甲状旁腺激素(iPTH)水平呈负相关(r=－0.800,P＜0.01);血清钙、磷酸盐及肌酐水平与部分脑区FA及AD呈负相关(r均＜0,P均＜0.05),血清磷酸盐水平与部分脑区RD呈正相关(r均＞0,P均＜0.05)。结论 ESRD SHPT患者存在认知功能障碍;其脑白质微结构广泛损伤并以轴突损伤为主,具有右侧大脑半球偏侧性,且与血清钙、磷酸盐及肌酐水平相关。 |
| 英文摘要: |
| Objective To investigate cognitive and white matter microstructure damage in end-stage renal disease (ESRD) patients with secondary hyperparathyroidism (SHPT) with diffusion tensor imaging (DTI). Methods Data of 50 ESRD patients were retrospectively analyzed. The patients were divided into SHPT group or control group (each n=25) according to with hyperparathyroidism or not. The outcomes of mini-mental state examination (MMSE) were recorded, and the relevant clinical serological indicators were collected. Brain DTI data were reviewed, and anisotropy fraction (FA), mean diffusivity (MD), axial diffusivity (AD) and radial diffusivity (RD) obtained with DTI were compared between groups. The correlations of MMSE score, serological indicators and DTI parameters of brain regions being significantly different between control group and SHPT group were analyzed. Results Compared with control group, MMSE scores in SHPT group significantly reduced, while serum calcium level slightly increased (both P＜0.05). In SHPT group, FA and AD decreased in many brain regions, including cerebral hemisphere, cerebellum and brainstem, which in cerebral hemisphere mainly distributed in the right side, while RD increased in some brain regions. MMSE scores in SHPT group were negatively correlated with intact parathyroid hormone (iPTH) level (r=－0.800, P＜0.01). Serum calcium, phosphate and creatinine levels in SHPT group were negatively correlated with FA and AD (all r＜0, all P＜0.05), while serum phosphate level was positively correlated with RD in some brain regions (all r＞0, all P＜0.05). Conclusion Patients with ESRD and SHPT had cognitive dysfunction and extensive white matter microstructure damages, mainly present as axon damage, with right hemisphere lateralization and related to serum calcium, phosphate and creatinine levels. |
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