Application Of Diffusion Tensor Imaging In ESRD With Depression

Objective To investigate the value of diffusion tensor imaging?DTI?in the changes of white matter microstructure in end-state renal disease?ESRD?patients with depression.Materials and Methods Collection of ESRD patients and normal physical examiners from December 2016 to June 2018 in affiliated Hospital of Qingdao University,and group according to the following methods:A total of 28 ESRD patients with depression were collected as D-ESRD group,26 ESRD patients without depression were collected as nD-ESRD group,(the assessment of depression was assessed according to the Manual for diagnosis and Statistics of Mental Disorders-V?DSM-V?,Hamilton depression scale-17(HAMD₁₇)and neuropsychiatric questionnaire?NPI?were used for comprehensive evaluation),30 healthy subjects were collected as healthy control group.All subjects were examined by brain DTI.The relative parameters of DTI were analyzed by Tract-based spatial statistics?TBSS?.The changes of microstructure of white matter fibers in three groups were compared in whole brain by pairwise comparison.The clinical data and laboratory indexes(serum K⁺,Na⁺,Ca²⁺,urea nitrogen,creatinine,uric acid)of the three groups were compared and analyzed by independent sample T-test and factor analysis of variance.Spearman correlation analysis was used to analyze the correlation between brain area FA value and HAMD₁₇7 score in D-ESRD group.Spearman correlation analysis was used to analyze the correlation between laboratory examination index and HAMD₁₇7 score in D-ESRD group.Results?1?There was no significant difference in age,sex,duration of education and dialysis time among the three groups?p>0.05?,but there was significant difference in course of disease and HAMD₁₇7 score?p<0.05?;?2?The laboratory indexes with significant difference among the three groups included serum Ca²⁺?t=3.976,p=0.032?,creatinine?t=2.024,p=0.049?and urea nitrogen?t=2.930,p=0.037?;?3?Compared with HC group,the FA values of bilateral frontal-occipital tract,fornix,pontine,cerebral foot and bilateral external capsule were decreased in nD-ESRD group.Compared with HC group,the FA values of genu and body of the corpus callosum,cingulate bundle,bilateral anterior limb of internal capsule,bilateral superior longitudinal bundle,anterior thalamic radiation crown and bilateral frontal white matter were decreased in D-ESRD group?p<0.05?.Compared with nD-ESRD group,the FA values of bilateral frontal-occipital bundle,radiation crown,corpus callosum knee and corpus callosum compression,bilateral internal capsule and pontine,Bilateral inferior longitudinal bundle and part of upper longitudinal bundle were decreased in D-ESRD group.?4?There was a significant correlation between the FA values of left frontal white matter?r=-0.672,p=0.003?and left anterior limb of internal capsule?r=-0.476,p=0.023?in D-ESRD group.There was a significant correlation between serum Ca²⁺?r=0.581,P=0.031?and urea nitrogen?r=0.796,P=0.003?and HAMD₁₇7 score in D-ESRD group.Conclusions The significant increase of serum Ca²⁺and urea nitrogen levels in patients with end-stage nephropathy may be related to the pathogenesis of emotional disorders such as depression.As a non-invasive imaging method to detect the changes of white matter fiber microstructure,DTI can be used as a reference index for diagnosis of depression in patients with ESRD and early diagnosis of depression in patients with ESRD,especially the change of FA value,which can be used as a reference index for the diagnosis of depression in patients with ESRD,and early treatment provides a theoretical basis.