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目的:采用静息态功能磁共振成像(rs-fMRI)研究肾移植对终末期肾病患者脑默认网络(DMN)的影响。方法:21例拟行肾移植手术的终末期肾病患者(患者组)和22例健康志愿者(对照组)纳入本组研究。22例健康志愿者及21例患者术前、术后(平均38d,范围25~69d)均行rs-fMRI检查。利用独立成分分析方法分离得到各受试者的默认网络脑区,采用单样本t检验对患者术前和对照组进行组内分析,观察各自的DMN空间分布模式;分别对患者肾移植术前与正常对照组、肾移植后与术前DMN功能连接进行组间比较,观察静息状态下脑默认网络的改变情况。结果:肾移植术前患者组和正常对照组均显示出典型的脑默认网络空间分布模式。与正常对照组相比,肾移植术前患者组默认网络脑区功能连接既有降低也有增高,降低脑区包括双侧额上回、双侧海马旁回、右侧颞中回及颞上回;增高脑区主要位于双侧楔前叶、双侧顶下小叶及内侧前额叶。与肾移植术前相比,肾移植术后患者出现右侧颞中回、双侧内侧额上回及额上回功能连接的增强。结论:终末期肾病患者肾移植术后早期即出现脑默认网络功能连接的增强,提示肾移植可改善终末期肾病患者默认网络脑区的功能。
Objective: To investigate the effect of renal transplantation on brain default network (DMN) in patients with end-stage renal disease by resting state functional magnetic resonance imaging (rs-fMRI). Methods: Twenty-one patients with end-stage renal disease (patient group) and 22 healthy volunteers (control group) were enrolled in this study. Twenty-two healthy volunteers and 21 patients underwent preoperative and postoperative examinations (mean 38 days, range, 25-69 days) underwent rs-fMRI. Using independent component analysis method, the default network brain regions of each subject were isolated. The single-sample t-test was used to analyze the preoperative and control groups of patients and to observe their spatial distribution patterns of DMN. Normal control group, renal transplantation and preoperative DMN functional connection between the two groups to observe the resting state of the brain default network changes. Results: The pretreatment renal transplantation group and the normal control group showed the typical pattern of brain spatial distribution. Compared with the normal control group, the default network brain function connection in both groups before and after kidney transplantation decreased and increased, and decreased the brain area including bilateral upper frontal gyrus, bilateral parahippocampal gyrus, right middle temporal gyrus and superior temporal gyrus ; Increased brain area is mainly located in the bilateral wedge anterior lobe, both the top of the leaflets and medial prefrontal lobes. Compared with those before kidney transplantation, the right middle temporal gyrus, the bilateral medial frontal gyrus, and the superior frontal gyrus increased after renal transplantation. CONCLUSIONS: The increase of brain default network functional connectivity occurs early after kidney transplantation in patients with end-stage renal disease, suggesting that kidney transplantation may improve the function of the default network brain region in patients with end-stage renal disease.