PDF(Pubmed)
Abstract：
OBJECTIVE: Restless legs syndrome (RLS) stands as a prevalent neurological complication within maintenance hemodialysis (MHD) patients. However, the alterations in cerebral blood flow (CBF) among MHD-RLS patients remain uncharted. Through the utilization of the arterial spin labeling (ASL) technique, we evaluated the fluctuations in CBF within distinct brain regions and analyzed the risk factors for the development of RLS in MHD patients in the context of the clinic.
METHODS: Thirty-one MHD patients with concomitant RLS (MHD-RLS group) and thirty-one non-RLS patients matched based on age, gender, as well as cognitive function (MHD-nRLS group) were included. Through image preprocessing and data analysis, the changes in CBF values in distinct brain regions were obtained, and the CBF values of brain regions with substantial differences between the two groups were correlated with the RLS scores. Furthermore, the differences in baseline data were compared, and through the utilization of multifactorial logistic regression, the independent risk factors for the development of RLS were examined.
RESULTS: Compared with the MHD-nRLS group, the MHD-RLS group had increased CBF in the right superior temporal gyrus, reduced CBF in the right hippocampus, left middle frontal gyrus, inferior frontal gyrus of right triangle, middle frontal gyrus of left orbit, left precentral gyrus, and left precuneus. Only left precentral gyrus CBF were negatively correlated with RLS scores after correction for dialysis duration(r = -0.436, P = 0.016). Accordingly, multifactorial regression analysis by stepwise method yielded that the left precentral gyrus CBF values(OR: 0.968, 95%CI: 0.944-0.993, P = 0.012) remained an independent risk factor for RLS in MHD patients. In addition, the results showed that hemodialysis duration (OR: 1.055, 95%CI: 1.014-1.098, P = 0.008) and serum iron levels (OR: 0.685, 95%CI: 0.551-0.852, P = 0.001) were also risk factors for the development of RLS.
CONCLUSIONS: Patients afflicted with MHD-RLS exhibit alterations in CBF across several brain regions. Notably, the left precentral gyrus might serve as a pivotal region influencing the onset of RLS among MHD patients. Furthermore, extended hemodialysis duration and a relative insufficiency in serum iron levels independently contribute as risk factors for RLS development within the MHD patient population.
METHODS: Thirty-one MHD patients with concomitant RLS (MHD-RLS group) and thirty-one non-RLS patients matched based on age, gender, as well as cognitive function (MHD-nRLS group) were included. Through image preprocessing and data analysis, the changes in CBF values in distinct brain regions were obtained, and the CBF values of brain regions with substantial differences between the two groups were correlated with the RLS scores. Furthermore, the differences in baseline data were compared, and through the utilization of multifactorial logistic regression, the independent risk factors for the development of RLS were examined.
RESULTS: Compared with the MHD-nRLS group, the MHD-RLS group had increased CBF in the right superior temporal gyrus, reduced CBF in the right hippocampus, left middle frontal gyrus, inferior frontal gyrus of right triangle, middle frontal gyrus of left orbit, left precentral gyrus, and left precuneus. Only left precentral gyrus CBF were negatively correlated with RLS scores after correction for dialysis duration(r = -0.436, P = 0.016). Accordingly, multifactorial regression analysis by stepwise method yielded that the left precentral gyrus CBF values(OR: 0.968, 95%CI: 0.944-0.993, P = 0.012) remained an independent risk factor for RLS in MHD patients. In addition, the results showed that hemodialysis duration (OR: 1.055, 95%CI: 1.014-1.098, P = 0.008) and serum iron levels (OR: 0.685, 95%CI: 0.551-0.852, P = 0.001) were also risk factors for the development of RLS.
CONCLUSIONS: Patients afflicted with MHD-RLS exhibit alterations in CBF across several brain regions. Notably, the left precentral gyrus might serve as a pivotal region influencing the onset of RLS among MHD patients. Furthermore, extended hemodialysis duration and a relative insufficiency in serum iron levels independently contribute as risk factors for RLS development within the MHD patient population.
摘要：
目的：不安腿综合征（RLS）是维持性血液透析（MHD）患者普遍存在的神经系统并发症。然而,MHD-RLS患者的脑血流量(CBF)改变仍然未知.通过利用动脉自旋标记(ASL)技术，我们评估了不同脑区CBF的波动,并结合临床分析了MHD患者发生RLS的危险因素.
方法：31例MHD合并RLS患者（MHD-RLS组）和31例非RLS患者根据年龄匹配，性别,以及认知功能（MHD-nRLS组）。通过图像预处理和数据分析,获得了不同大脑区域CBF值的变化，两组间差异较大的脑区CBF值与RLS评分相关。此外，比较了基线数据的差异，通过利用多因素逻辑回归，研究了发生RLS的独立危险因素.
结果：与MHD-nRLS组相比，MHD-RLS组右颞上回CBF升高,右侧海马的CBF减少,左额中回,直角三角形额下回,左眶中额回,左中前回,离开了普雷苏斯.仅左中央前回CBF与透析时间校正后的RLS评分呈负相关(r=-0.436,P=0.016)。因此，通过逐步方法的多因素回归分析得出，左中前回CBF值（OR：0.968，95CI：0.944-0.993，P=0.012）仍然是MHD患者RLS的独立危险因素。此外,结果表明，血液透析时间（OR：1.055，95CI：1.014-1.098，P=0.008）和血清铁水平（OR：0.685，95CI：0.551-0.852，P=0.001）也是发生RLS的危险因素。
结论：患有MHD-RLS的患者在多个脑区表现出CBF的改变。值得注意的是,左中央前回可能是影响MHD患者RLS发病的关键区域.此外，血液透析持续时间延长和血清铁水平相对不足是MHD患者发生RLS的危险因素.
方法：31例MHD合并RLS患者（MHD-RLS组）和31例非RLS患者根据年龄匹配，性别,以及认知功能（MHD-nRLS组）。通过图像预处理和数据分析,获得了不同大脑区域CBF值的变化，两组间差异较大的脑区CBF值与RLS评分相关。此外，比较了基线数据的差异，通过利用多因素逻辑回归，研究了发生RLS的独立危险因素.
结果：与MHD-nRLS组相比，MHD-RLS组右颞上回CBF升高,右侧海马的CBF减少,左额中回,直角三角形额下回,左眶中额回,左中前回,离开了普雷苏斯.仅左中央前回CBF与透析时间校正后的RLS评分呈负相关(r=-0.436,P=0.016)。因此，通过逐步方法的多因素回归分析得出，左中前回CBF值（OR：0.968，95CI：0.944-0.993，P=0.012）仍然是MHD患者RLS的独立危险因素。此外,结果表明，血液透析时间（OR：1.055，95CI：1.014-1.098，P=0.008）和血清铁水平（OR：0.685，95CI：0.551-0.852，P=0.001）也是发生RLS的危险因素。
结论：患有MHD-RLS的患者在多个脑区表现出CBF的改变。值得注意的是,左中央前回可能是影响MHD患者RLS发病的关键区域.此外，血液透析持续时间延长和血清铁水平相对不足是MHD患者发生RLS的危险因素.
