| Background: With the aging of the population in China,the incidence of end-stage renal disease（ESRD）is increasing year by year.ESRD patients usually show various types of neurological damage,which affects the prognosis and quality of life.Cognitive dysfunction is easily ignored and its specific mechanism is not clear.Previous studies have suggested that the impairment of cognitive function in ESRD patients was associated with structural changes of the cerebral white matter,which could be detected by diffusion tensor imaging.To explore the neural mechanisms of cognitive impairment in ESRD patients,the structural changes of white matter may be tested by diffusion tensor imaging of MRI,combining with the examination of clinical biochemical.index and cognitive function.Objective: To explore the underlying mechanism of cerebral white matter microstructural changes and cognitive impairment in patients with end-stage renal disease used diffusion tensor imaging-based TBSS analysis method and XTRACT fiber tract extraction technique.Methods: 64（24 males,40 females）ESRD patients and 47（24 males,23 females）healthy controls matched for age,sex,and years of education were recruited.The diffusion tensor data of the two groups were collected and detected by TBSS analysis method and XTRACT white matter extraction technology.Two independent samples t test was performed on the diffusion data of the two groups to analyze the changes in the microstructure of the white matter of the two groups and the regions with significant differences.Also,the two groups of subjects were tested with neuropsychological cognitive scales,including the MMSE,TMT-A and Mo CA.The blood biochemical indices such as serum creatinine,blood urea nitrogen and hemoglobin of the patient group were collected.Finally,Pearson correlation analysis was performed between the white matter regions with significant differences in ESRD patients and clinical data,blood biochemical indexes and neuropsychological cognitive scale test scores.Results:1.General clinical data and cognitive scale test results of the two groups There were no significant differences in general information between the patients with end-stage renal disease and the healthy control group（P < 0.05）.Compared with the healthy control group,the MMSE and Mo CA scores of the ESRD patient group were decreased（P < 0.01）,and the TMT-A’s score was increased（P < 0.05）.2.Results of the white matter in the two groups Compared with the healthy control group,the FA value of the ESRD patient group was generally lower,while the MD value,AD value and RD value were generally increased,mainly manifested in the arcuate fasciculus,acoustic radiation,anterior thalamic radiation,temporal,corticospinal tract,frontal aslant tract,forceps major,inferior fronto-occipital fasciculus,inferior longitudinal fasciculus,middle cerebellar peduncle,middle longitudinal fasciculus,optic radiation,superior longitudinal fasciculus,superior thalamic radiation,uncinate fasciculus,right vertical occipital fasciculus.The difference was statistically significant（P < 0.05）.3.Correlation analysis results of white matter fiber tracts and cognitive scales,biochemical indicators and disease course In the ESRD group,the values of FA in the arcuate fasciculus were positively correlated with Mo CA’s scores and the levels of hemoglobin,and the values of MD and RD of these tracts were positively correlated with the levels of hemoglobin and creatinine and positively correlated with the scores of MMSE and Mo CA.The values of FA in acoustic radiation were negatively correlated with the TMT-A’s scores and the concentration of creatinine and urea and positively correlated with the scores of MMSE and Mo CA and the levels of hemoglobin,and the values of MD and RD of these tracts were positively correlated with the concentration of creatinine and urea and the TMT-A’s scores and negatively correlated with the scores of MMSE and Mo CA.The values of FA in optic radiation were negatively correlated with the TMT-A’s scores and the concentration of creatinine and positively correlated with the Mo CA’s scores and the levels of hemoglobin,and the values of RD of these tracts were positively correlated with the concentration of urea.The values of FA in the anterior thalamic radiation were negatively correlated with the concentration of urea and creatinine and positively correlated with the Mo CA’s scores and the levels of hemoglobin,and the values of MD and RD of these tracts were positively correlated with the concentration of urea.The values of FA in the temporal were negatively correlated with the scores of TMT-A and positively correlated with the Mo CA’s scores and the levels of hemoglobin,and the values of MD and RD of these tracts were positively correlated with the concentration of creatinine and urea and negatively correlated with the levels of hemoglobin.The values of FA in the corticospinal tract were positively correlated with the Mo CA’s scores and the levels of hemoglobin,and the values of MD,AD and RD of these tracts were positively correlated with the concentration of urea and negatively correlated with the levels of hemoglobin.The values of FA in the frontal aslant tract were positively correlated with the Mo CA’s scores,and the values of MD,AD and RD of these tracts were positively correlated with the concentration of urea.The values of FA in the forceps major were negatively correlated with the concentration of urea,and the values of MD,AD and RD of these tracts were negatively correlated with the levels of hemoglobin.The values of FA in the inferior fronto-occipital fasciculus were negatively correlated with the concentration of creatinine and positively correlated with the Mo CA’s scores,and the values of MD,AD and RD of these tracts were negatively correlated with the levels of hemoglobin.The values of FA in the right inferior longitudinal fasciculus were negatively correlated with the concentration of creatinine and positively correlated with the levels of hemoglobin,and the values of MD,AD and RD of these tracts were negatively correlated with the levels of hemoglobin.The values of FA in the middle longitudinal fasciculus were negatively correlated with the concentration of creatinine and positively correlated with the levels of hemoglobin and the Mo CA’s scores,and the values of MD of these tracts were negatively correlated with the levels of hemoglobin.The values of FA in the superior longitudinal fasciculus and the superior thalamic radiation were negatively correlated with the concentration of urea and positively correlated with the levels of hemoglobin and the Mo CA’s scores.The values of MD,AD and RD in the superior thalamic radiation were positively correlated with the concentration of urea and the disease course,and negatively correlated with the levels of hemoglobin.The values of FA in the uncinate fasciculus and the vertical occipital fasciculus were negatively correlated with the concentration of creatinine and positively correlated with the levels of hemoglobin and the Mo CA’s scores.The values of MD and RD in the vertical occipital fasciculus were positively correlated with the concentration of creatinine and urea and negatively correlated with the levels of hemoglobin.The values of FA in the middle cerebellar peduncle were negatively correlated with the disease course.The values of MD and AD in the fornix were positively correlated with the concentration of creatinine and urea.Conclusion: There is extensive damage to the microstructure of white matter in ESRD patients,which is significantly related to cognitive decline and biochemical substances such as creatinine,blood urea nitrogen,and hemoglobin.It suggests that the extensive damage of white matter in ESRD patients is involved in the neural mechanism of various cognitive dysfunctions.Abnormal levels of serum creatinine,blood urea nitrogen and hemoglobin may be risk factors for the damage of the whole cerebral white matter fiber bundles in ESRD patients,and white matter damage is also associated with cognitive decline. |
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