Altered Amplitude Of Low Frequency Fluctuation And Functional Connectivity In Patients With End-stage Renal Disease

Objectives:To investigate the mechanism of abnormal brain function in patients with end-stage renal disease?ESRD?by using resting-state functional magnetic resonance imaging?rs-fMRI?scanning and post-processing method based on amplitude of low frequency fluctuation?ALFF?as functional connectivity?FC?in the region of interest?ROI?.The correlation analysis was performed with the patient's neuropsychological test scale and some clinical biomarkers to explore whether the abnormal brain function is related to the patient's neuropsychological changes,and to observe whether there are potential clinical biomarkers to detect the abnormal brain function.Methods:Based on the rs-fMRI data of 29 ESRD patients and 31 health controls?HC?.all subjects received routine MRI sequence scans?including T1WI?T2WI?DWI?T2-FLAIR?to exclude other organic lesions including acute cerebral infarction.After the above anomalies are excluded,the rs-fMRI sequence scan is carried out to collect the scanning data.All subjects underwent neuropsychological tests,including Montreal Cognitive Assessment?MoCA?and Mini-Mental State Examination?MMSE?,and collected relevant laboratory data of ESRD patients?including hemoglobin,serum creatinine,blood urea nitrogen and blood calcium?Rs-f MRI image was preprocessed based on the SPM₈ toolkit,DPABI_V4.3 software package of the MATLAB₂012 platform to obtain the low frequency amplitude?ALFF?activation map in the resting state of all subjects.ALFF abnormal brain regions were then used as regions of interest?regions of interest,ROI?to analyze the FC,between the abnormal brain regions and other regions of the whole brain to evaluate the function of the network level of the patient's brain,and to preliminarily explore the mechanism of ESRD the abnormal brain function of the patient.Results:Compared with the HC group,the ALFF signal in bilateral hippocampus and left caudate nucleus increased significantly,and the ALFF signal in left central posterior gyrus and right middle frontal gyrus decreased?FDR correction,P<0.01?.ESRD patients had abnormal functional connections between the ALFF signal abnormal brain region and some brain regions,the FC between the right parahippocampal gyrus and the right anterior central gyrus decreased,the left parahippocampal gyrus and the left medial and paraspinal gyrus FC decreased;the left caudate nucleus increased with the right anterior cingulate and paraspinal gyrus FC increased;the left inferior parietal gyrus increased with the left medial frontal gyrus and the left paracentral lobule increased?FDR correction,P<0.01??The negative correlations between mean ALFF values of the left caudate head and the MOCA score?Conclusion:ESRD most of the patients have different degrees of cognitive decline and brain function at the same time abnormal.Rs-fMRI is a promising tool for detecting changes in brain function in ESRD patients and can be used to assist in clinical diagnosis of patients with neuropsychiatric state abnormalities.the decrease and increase of ALFF signals in local brain regions,as well as the increase of FC between these regions and other brain regions in resting state,can provide a basis for the hypothesis of multiple neurophysiological mechanisms.these findings help us to further understand the effects of spontaneous brain function in ESRD patients and provide a possible theoretical basis for neuroprotective measures.