中文摘要：

目的：采用伪连续式动脉自旋标记法（pCASL）MRI对终末期肾病（ESRD）患者的脑灌注变化进行无创性测量,并讨论这种改变与认知功能障碍之间的关系。方法：将40例ESRD患者和40例性别、年龄相匹配的健康志愿者纳入研究,所有受试者进行实验室检查（血红蛋白、血肌酐和尿素）和神经心理学测试[包括数字连接试验-A（NCT-A）、数字符号试验（DST）、焦虑自评量表（SAS）和抑郁自评量表（SDS）],随后行pCASL-MRI检查,测量全脑、脑灰质和脑白质区的脑血流量（CBF）。对两组间的各项资料进行统计学分析。结果：ESRD组全脑、灰质和白质的CBF值均明显高于正常对照组,差异有统计学意义（P〈0.01）;两组间DST、SAS和SDS分值的差异有统计学意义（P〈0.05）,而NCT-A分值的差异无统计学意义（P〉0.05）。ESRD患者的全脑、灰质和白质的CBF值与血红蛋白含量间均呈明显负相关关系（P〈0.01）,与DST分值亦呈负相关关系（P〈0.05）;血红蛋白含量与DST分值间呈明显正相关关系（P〈0.05）。而血肌酐和尿素含量与各神经心理学量表分值间无显著相关关系（P〉0.05）。结论：ESRD患者的认知功能较健康人群减低,这种改变与其脑组织血流灌注以及血红蛋白含量具有显著相关性。

英文摘要：

Objectives：To noninvasively assess changes of cerebral perfusion in patients with end-stage renal disease （ESRD） using the pseudo continuous arterial spin labeling （pCASL） MRI,and to identify the relationships between these changes and the cognitive impairments. Methods：Forty ESRD patients and 40 sex- and age-matched healthy volunteers were recruited. Laboratory examinations including hemoglobin content, serum creatinine and urea levels were made, and neuropsy- chological evaluation using the number connection test type A （NCT-A）, the digital symbol test （DST）, the self rating anxietys scale （SAS） and the self rating depression scale （SDS） was performed. Then pCASL MRI was peformed,and the mean values of cerebral blood flow （CBF） of the whole brain,gray matter and white matter were measured. The clinical and laboratory data,neuropsychological scale data and cerebral blood flow （CBF） data of the two groups were compared statisti- cally. Results：CBFs of the ESRD group were significantly higher than those of the control group （P〈 0.01 ）. There were statistically significant differences in DST,SAS and SDS scores between the two groups （P〈0.05） ,and no obvious differ- ence was found in NCT-A scores （P〉0.05）. There were significant negative correlations between CBF of the whole brain, gray matter, white matter and the hemoglobin content or DST score （P〈0.05）. The hemoglobin content was positively cor- related with DST score （P〈0.05）. No significant correlation was found between the levd of serum creatinine and urea and the scores of four neuropsychological scales （P〉0.05）. Conclusion：The cognitive function of ESRD patients is significantly lower than that of normal subjects,and the changes are significantly correlated with the elevation of CBF and the content of hemoglobin.