慢性腎臟病人認知功能缺損與海馬迴萎縮之關聯研究

Abstract

長久以來慢性腎臟病人的認知功能缺損已經廣為注意，也有不少文獻提及，但是腦部結構變化以及認知表現和腎臟功能的關聯則很少被提及，到本論文旨在探討這三者之間的關聯性。本研究共納入了性別年齡相似的慢性腎臟病人(CKD)實驗組及正常腎功能對照組，每位受試者皆有接受腎功能檢查、完整的神經心知功能評估以及腦部核磁共振檢查(MRI)，腦部影像資料藉由軟體FreeSurfer分析可以獲得腦部結構的各項參數，並藉此與臨床腎功能與心智功能量表進行統計分析，結果發現相較於對照組，實驗組(CKD)有較低的簡單心智功能評估分數(Mini-Mental State Examination, MMSE)，較小的腦部灰質體積、海馬迴大小及皮質厚度。而估算腎絲球過濾率(eGFR)則與前述四項有明顯相關性，進一步校正干擾因子(confounding factors)線性分析發現，eGFR對於認知功能、灰質體積及皮質厚度有明顯負相關。結論在本研究中發現腎功能缺損在心智認知功能以及大腦結構之灰質體積，海馬迴體積以及皮質厚度有明顯相關。

Cognition impairment is well known in patients with chronic kidney disease (CKD). The relationship between brain structure and cognitive performance in CKD patients is still under investigation. The study aims to quantitatively assessment the relationship between brain structure and cognitive performance in patients with CKD. 39 patients with CKD and 39 age- and sex-matched control participants are recruited from a tertiary medical center. All participants underwent 3-T MRI scan neuropsychological assessments, and renal function tests. FreeSurfer software was used for imaging processing and analysis, including measurement of cortical thickness and gray matter (GM) and white matter volumes. As a result, compared with control subjects (73.1 ± 7.5 years old), patients with CKD (76.4 ± 8.4 years old) had significantly lower scores on the Mini-Mental State Examination, and forward digit span test (p < 0.01). Patients with CKD had smaller cerebral GM volume, hippocampus and decreased cortical thickness (p < 0.01) relative to the control group. Estimated glomerular filtration rate (eGFR) was correlated with cognitive performance, cortical thickness, GM volume, and hippocampal volume (p < 0.001). Linear regression analysis revealed that eGFR and GM volume were independently negatively associated with cognitive performance (p < 0.001), while eGFR and age were negatively associated with cortical thinning and GM volume after controlling for confounding factors. In conclusion, this study demonstrated that impaired kidney function is associated not only with poor cognitive performance, but also with small cerebral GM volume and reduced cortical thickness.