White matter damage in maintenance hemodialysis patients: a diffusion tensor imaging study.
White matter damage in maintenance hemodialysis patients: a diffusion tensor imaging study.
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DOI：
10.1186/s12882-017-0628-0
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发表时间：
2017-07-05
期刊：
影响因子：
2.3
通讯作者：
Sarnak MJ
中科院分区：
文献类型：
--
作者：
Drew DA;Koo BB;Bhadelia R;Weiner DE;Duncan S;la Garza MM;Gupta A;Tighiouart H;Scott T;Sarnak MJ
接受透析治疗的患者发生脑梗死、脑萎缩和白色疾病的几率很高。关于脑白色物质存在更细微损伤的数据有限。在认知和透析研究中，我们使用弥散张量成像比较了血液透析（HD）患者与无已知肾脏疾病的个体的大脑结构，使用基于束的空间统计（TBSS）比较分数各向异性（FA）和平均弥散度（MD）。每个重叠体素的统计比较是使用基于置换的校正p值<0.05进行年龄控制的。34例HD患者和26例对照（HD组52岁，对照组51岁）有足够的磁共振成像进行分析。HD组的女性人数较少（38% vs 23%），糖尿病（29% vs 8%）、心力衰竭（29% vs 0%）和临床中风（15% vs 0%）的患病率较高。血液透析患者在多个白色物质纤维束中FA显著降低，额颞连接、胼胝体和穹窿的前部比大脑后部受影响更显著。同样，HD患者在多个前脑区域的平均扩散率显著较高。当排除有卒中病史的患者时，结果仍然相似。在HD患者中，与无肾脏疾病的对照组相比，大脑前部的白色病变多于后部。这种损伤模式与衰老中观察到的最相似，表明慢性肾脏疾病的发展和最终的肾衰竭可能导致与加速衰老一致的表型。
Patients treated with dialysis have high rates of brain infarcts, brain atrophy, and white matter disease. There are limited data regarding the presence of more subtle damage to brain white matter. In the Cognition and Dialysis Study, we compared brain structure using diffusion tensor imaging in hemodialysis (HD) patients to individuals without known kidney disease, using tract based spatial statistics (TBSS) to compare Fractional Anisotropy (FA) and Mean Diffusivity (MD). Statistical comparison of each overlaid voxel was age controlled using a permutation based corrected p value of <0.05. Thirty-four HD patients and twenty six controls (52 vs 51 years for HD vs control) had adequate magnetic resonance imaging for analysis. The HD group had fewer women (38% vs 23%) and a higher prevalence of diabetes (29% vs 8%), heart failure (29% vs 0%) and clinical stroke (15% vs 0%). Hemodialysis patients had significantly lower FA across multiple white matter fiber tracts, with fronto-temporal connections, the genu of the corpus callosum and the fornix more significantly affected than posterior regions of the brain. Similarly, HD patients had significantly higher mean diffusivity in multiple anterior brain regions. Results remained similar when those with a prior history of stroke were excluded. In HD patients, there is more white matter disease in the anterior than posterior parts of the brain compared to controls without kidney disease. This pattern of injury is most similar to that seen in aging, suggesting that developing chronic kidney disease and ultimately kidney failure may result in a phenotype consistent with accelerated aging.