DTI Based MRI Study Of Patients With End-stage Renal Disease Accompanied By Sleep Disorder

Objective: The aim of this study is to investigate the changes of white matter integrity in patients with end stage renal disease(ESRD)accompanied by sleep disorder who maintenaning hemodialysis by using atlas-based analysis method based on diffusion tensor imaging(DTI),and to analysis the correlations between the DTI evaluation indicators and neurocognitive function tests and clinical biochemical indexes,respectivity.Materials and methods: From October 2016 to October 2018,Forty-three ESRD patients who received maintaining hemodialysis treatment in the hemodialysis center of Nephrology Department of Affiliated Zhongshan Hospital of Dalian University were recruited as patient group.According to Pittsburgh Sleep Quality Index(PSQI)scores,the patient group was divided into two groups: one group with sleep disorders(SD,23 patients,15 male and 8 female,mean age 52.96±8.85 years);the other group without sleep disorders(NSD,20 patients,14 male and 6 female,mean age 47.75±11.64 years).Twenty-three age,sex,education and BMI matched normal subjects were recruited as healthy normal controls(HC,23 subjects,11 male and 12 female,mean age 55.09±9.90 years).Clinical blood biochemical indexes were measured the SD and NSD groups,such as serum creatinine,urea nitrogen,blood potassium,blood calcium,blood phosphorus,within 24 hours after the hemodialysis,then subsequently accepted MRI scans and neuropsychological scale tests(Mo CA,TMT_A,DST,SAS and SDS).The original DTI datas of all subjects were collected and processed by using atlas-based analysis method based on diffusion tensor imaging(DTI).Whole-brain white matter data were parcellated into 50 regions based on the anatomical ICBM-DTI-81 Atlas,regional diffusion metrics consisting of fractional anisotropy,mean diffusivity,radial diffusivity,axial diffusivity were calculated for each region.SPSS 19.0 was used for statistical analysis,and one-way anova was used to analysis the differences of DTI indexes between three groups,followed by pair-wise comparison.Correlation analysis was conducted between the SD and the NSD groups changes of the DTI indexes and NSD groups and neuropsychological scale scores and blood biochemical indexes,respectivity.Result: 1.There were no significant difference in demographic datas(gender,age,education,BMI)among the three groups(p>0.05).K+ in the SD group were significantly higher than that in the NSD group(p=0.042).There were no significant differences in serum creatinine,urea nitrogen,calcium and phosphorus between the two groups(p>0.05).The differences of PSQI,Mo CA,TMT_A,DST,SAS and SDS scores among the three groups were statistically significant(p<0.05).The scores of PSQI,TMT_A,DST,SAS and SDS scores in the SD group were significantly higher than those in the HC group(p<0.05).Mo CA scores of SD and NSD group were significantly lower than that of the HC group(p<0.05),and Mo CA scores of the SD group were significantly lower than that of the NSD group(p=0.036).2.Except the left hippocampus part of cingulate,the differences of fractional anisotropy in all white matter regions were statistically significant(p<0.05)between three groups,all white matter regions showed increased mean diffusivity(MD)and radial diffusivity(RD).In addition,axial diffusivity(AD)were significantly different in thirty-six white matter regions,such as middle cerebellar peduncle,bilateral corticospinal tract,inferior cerebellar peduncle,bilateral anterior corona radiata,and bilateral Superior corona radiata,bilateral anterior limb of internal capsule,and so on(p<0.05).Compared with the HC group,almost all regions had decreased FA,increased MD and RD in the SD group(p<0.05).However,32 brain regions showed the increased AD in right corticospinal tract,right inferior cerebellar peduncle,bilateral anterior corona radiata,bilateral superior corona radiata,bilateral anterior limb of internal capsule and so on(p<0.05).Compared with the HC group,the NSD patients showed significantly decreased FA in multiple regions,and increased MD and RD in all brain regions(p<0.05).However,the 35 white matter areas showed increased AD,including middle cerebellar peduncle,bilateral corticospinal tract,bilateral inferior cerebellar peduncle,bilateral anterior corona radiata,bilateral superior corona radiata,bilateral anterior limb of internal capsule,etc.Compared with the NSD group,the SD group showed decreased FA in the left corticospinal tract,left anterior limb of internal capsule,left anterior corona radiate,left superior corona radiate,left sagittal stratum,and increased FA in the right uncinated fasciculus.The MD of the SD group in the right corticospinal tract and left inferior cerebellar peduncle was lower than that of the NSD group(p<0.05).and The AD of middle cerebellar peduncle,right corticospinal tract and left inferior cerebellar peduncle were decreased significantly.However,there were no statistically significant differences in RD between the two groups(p>0.05).3.In the SD patients,the FA of the right uncinated fasciculus was positively correlated with Mo CA scores and negatively correlated with TMT_A scores(r=0.545,p=0.013;r=-0.464,p=0.039),while the FA of the left anterior coronal radiation was positively correlated with DST scores(r=0.586,p=0.007).The MD was negatively correlated with SAS scores at left inferior cerebellar peduncle(r=-0.463,p=0.040).However,there was no correlation between the FA,MD,AD and RD values and PSQI scores in all different brain regions(p>0.05).Conclusion: 1.Quantitative DTI of ESRD patients with sleep disorders who maintaining hemodialysis showed abnormal changes in white matter microstructures in a wide range of brain regions,including almost all three major types of white matter fibers.2.DTI could evaluate the microstructure damages of white matter in ERSD patients with sleep disorders who maintaining hemodialysis,which can provide important the theoretical foundation for the neuropathological mechanisms of cognitive function damage in these patients.DTI showed that the damages of corona radiata and uncinated fasciculus may be one of the causes of cognitive impairment in these patients.3.Sleep disturbance may be an important risk factor for worsening the damage of white matter microstructures in ESRD patients,as well as a major factor for cognitive decline and negative emotions in those patients.