尿毒症不宁腿患者静息态脑功能磁共振局部一致性研究
Regional homogeneity on resting state fMRI in patients with uremic restless legs syndrome

摘要：目的 采用静息态功能磁共振成像评价尿毒症不宁腿(uremic restless legs syndrome, URLS)患者脑部自发神经活动的改变，并进行相关性分析，为URLS神经机制的探索提供客观依据。方法 对26例URLS患者和25例健康志愿者(对照组)进行静息态功能磁共振扫描，对患者组进行临床资料收集，计算两组的大脑局部一致性(ReHo)改变，并进行统计学分析。结果 与对照组比较，患者组存在情绪心理的异常，而且患者组双侧辅助运动区、双侧丘脑、左侧岛叶、左侧海马ReHo值较对照组均增高(P均<0.05)，前扣带回、双侧中央后回、右侧杏仁核ReHo值较对照组均减低(P均<0.05)；患者组RLS严重程度评分与透析龄(r=0.57, P=0.002)、甲状旁腺激素(r=0.419, P=0.033)、BAI(r=0.528, P=0.006)、BDI(r=0.567, P=0.003)呈正相关。结论 URLS患者症状严重程度与透析龄、甲状旁腺激素、焦虑、抑郁等因素相关；URLS患者感觉运动脑区神经元活动一致性存在异常，这种异常对解释维持性透析患者出现不宁腿症状提供了客观的影像学诊断依据。
ABSTRACT: Objective To study neuromechanism for uremic restless syndrome (URLS), functional MRI (fMRI) analysis and were used to explor main activity. Methods Resting state functional magnetic resonance imaging (MRI) was performed on 29 patients with uremic restless legs syndrome and 25 healthy controls. The values of the regional homogeneity (ReHo) of the two groups were calculated and analyzed statistically. Result As compared with the control group, patients with uremic restless legs syndrome showed emotional and mental abnormality. Increased ReHo values in bilateral supplementary motor area, bilateral thalamus, left insular lobe, left hippocampus (P<0.05), and decreased ReHo values in anterior cingulate gyrus, bilateral posterior central gyrus, right amygdala were found in patients with uremic restless legs syndrome (P<0.05). The severity score of RLS was respectively positively correlated with dialysis duration (r=0.57, P=0.002), PTH level (r=0.419, P=0.033) BAI (r=0.528, P=0.006), and BDI (r=0.567, P=0.003). Conclusion Neuronal activity in related brain area in patients with uremic restless legs syndrome were found. This abnormality provides an objective diagnostic basis for the explanation of restless legs syndrome in maintenance hemodialysis patients