【摘要】 目的 通过MRI三维液体抑制反转恢复（three dimensional-fluid attenuated inversion recovery, 3D-FLAIR）序列检测终末期肾病（end-stage renal disease, ESRD）患者脑白质高信号（white matter hyperintensities, WMH）的体积及分布特点，探讨病变发生是否存在特征性脑区以及WMH体积与临床生化指标和认知功能的相关性。材料与方法 共纳入81例ESRD患者及77例健康对照组MRI 3D-T1WI、3D-FLAIR图像数据及临床生化指标，利用CAT12软件分析3D-T1WI图像得到各个被试者全脑体积，利用病灶分割软件（lesion segmentation tool, LST）中的病灶预测算法（lesion prediction algorithm, LPA）分析3D-FLAIR图像得到被试者全脑WMH体积和分布图。使用两样本t检验和Mann-Whitney U检验分析两组间认知功能评分和WMH严重程度（全脑WMH体积与全脑体积比）的差异性，使用非参数映射（non-parametric mapping, NPM）软件中Liebermeister检验分析两组WMH分布图的差异性，采用偏相关分析控制年龄和性别的影响后，评估WMH严重程度与临床生化指标及认知功能之间的相关性，进一步根据WMH严重程度对两组进行判别，并绘制ROC曲线。结果 ESRD组认知功能评分低于对照组[蒙特利尔认知评估量表评分（Montreal Cognitive Assessment, MoCA）:22.44±5.23 vs. 26.06±3.20,P<0.001；简易智能状态检查量表评分（Mini-MentalStateExamination,MMSE）:25.96±3.81vs.28.61±1.85, P<0.001]; ESRD组WMH严重程度高于对照组[1.40(2.60) vs. 0.36(0.40),P<0.001];ESRD组侧脑室旁出现WMH的比例更高（Z值：1.914～6.483,P<0.05）;WMH严重程度与认知功能无关（P>0.05），与血清白蛋白和肾小球滤过率呈负相关（r=-0.337,P=0.002;r=-0.231,P=0.041）。ROC曲线下面积为0.817(95%CI:0.751～0.884)。结论 ESRD患者脑室周围白质易于受到损伤，且与肾功能和血清白蛋白下降密切相关，WMH可作为有效判别ESRD脑白质损害的重要影像学指标。更多还原

【Abstract】 Objective: To investigate the volume and distribution characteristics of white matter hyperintensities(WMH) in patients with end-stage renal disease(ESRD) using MRI three dimensional-fluid attenuated inversion recovery(3D-FLAIR), and to determine if specific brain regions are more susceptible to lesion development and to assess the relationship between WMH volume and clinical biochemical markers and cognitive function. Materials and Methods: MRI image data and clinical biochemical indices from 81 ESRD patients and 77healthy controls were collected. CAT12 software was used to analyze 3D-T1WI images to obtain the whole brain volume of each subject.The 3D-FLAIR images were analyzed by Lesion Prediction Algorithm(LPA) in Lesion Segmentation Tool(LST) to obtain the volume and distribution map of WMH. Two-sample t-test and Mann-Whitney U test were used to analyze the differences in cognitive function scores and the severity of WMH(the ratio of WMH to total brain volume) between the two groups. The Liebermeister test in non-parametric mapping(NPM) software was employed to compare the distribution maps between the two groups. After controlling for the effects of age and gender using partial correlation analysis, the correlations between the severity of WMH and both clinical biochemical indicators as well as cognitive function were assessed. Furthermore, the two groups were categorized according to the severity of WMH, and the ROC curve was constructed. Results: The cognitive function scores of the ESRD group were significantly lower compared to the control group [Montreal Cognitive Assessment(MoCA): 22.44 ± 5.23 vs. 26.06 ± 3.20, P < 0.001; Mini-Mental State Examination(MMSE): 25.96 ± 3.81vs. 28.61 ± 1.85, P < 0.001]. The severity of WMH in the ESRD group was significantly higher than in the control group [1.40(2.60) vs.0.36(0.40), P < 0.001]. The proportion of WMH in the ESRD group was also higher(Z: 1.914 to 6.483, P < 0.05). Although WMH severity was not associated with cognitive function(P > 0.05), it was negatively correlated with serum albumin and glomerular filtration rate(r =-0.337, P = 0.002; r =-0.231, P = 0.041). The area under the ROC curve was 0.817(95% CI: 0.751 to 0.884). Conclusions: Periventricular white matter is particularly vulnerable to damage in ESRD patients, which is closely linked to the decline in renal function and serum albumin levels. WMH serves as a significant imaging marker for effectively distinguishing white matter damage in ESRD.更多还原