儿童慢性肾病对脑完整性的影响：基于体积与磁共振波谱的联合分析
本研究为横断面研究，纳入63例2-12岁儿童慢性肾病（CKD）3-5期患者（含29例透析、34例非透析）与63例年龄性别匹配的健康对照，采用脑MRI自动体积分割和单体素磁共振波谱定量基底节和脑桥的NAA/Cr与Cho/Cr比值。结果显示CKD患儿存在广泛的脑体积减小和区域代谢改变，透析者更显著；脑桥代谢物比值与脑体积显著相关。
要点
- 儿童CKD 3-5期可出现全面性脑体积减小，透析者改变最显著。
- 基底节NAA/Cr降低、基底节和脑桥Cho/Cr升高，透析者更严重。
- 脑桥NAA/Cr与脑体积负相关，Cho/Cr与脑体积正相关。
关键影像表现/征象
- pCKD患者全脑、灰质、大脑、小脑及皮层下结构体积较对照组显著减小（p < 0.05），透析亚组改变最明显。
- 基底节NAA/Cr显著降低，基底节和脑桥Cho/Cr显著升高（p < 0.01），透析患者改变最严重。
- 脑桥NAA/Cr与脑体积呈显著负相关（p = 0.01），Cho/Cr与脑体积呈显著正相关（p = 0.014）。
- 基底节代谢改变在协变量为灰质体积后仍具统计学显著性（p ≤ 0.001）。
诊断标准与关键数值
- pCKD组与对照组比较采用独立t检验、单因素方差分析、Pearson/Spearman相关及以灰质体积为协变量的协方差分析（ANCOVA）。
- 体积减小以p < 0.05为显著，代谢物比值改变以p < 0.01为显著，相关分析以p = 0.01或p = 0.014为显著。
临床应用与阅片要点
- 对儿童CKD 3-5期患者，尤其是透析者，阅片时应关注脑体积减小和基底节、脑桥代谢物比值改变。
- 磁共振波谱所示基底节NAA/Cr降低和Cho/Cr升高可作为CKD相关脑损伤的候选影像标志物。
局限性
- 横断面设计无法推断因果关系。
- 样本量有限（63例患者），结果需更大样本验证。
- 原文未报告多中心数据，可能限制外推性。
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
英文原文（摘要）· 点击展开
PURPOSE: Investigation of structural brain volume alterations and metabolic changes in stages 3-5 pCKD using volumetric MRI with MR spectroscopy.
METHODS: In this cross-sectional study, 63 children with pCKD (stages 3-5; age range: 2-12 years), including 29 on dialysis and 34 not on dialysis, were compared to 63 age- and sex-matched healthy controls (age range: 3-11 years). All participants underwent brain MRI with automated volumetric segmentation (volBrain) and single-voxel spectroscopy to quantify N-acetylaspartate/creatine (NAA/Cr) and choline/creatine (Cho/Cr) ratios in the basal ganglia and pons. Group comparisons and correlation analyses between brain volumes and metabolite ratios were performed using independent t-tests, one-way ANOVA, Pearson/Spearman correlation, and analysis of covariance (ANCOVA) with grey matter volume as a covariate.
RESULTS: Patients with pCKD (stage 3-5) demonstrated significant, widespread reductions in brain volume, affecting total brain, grey matter, cerebrum, cerebellum, and subcortical structures compared to controls (p < 0.05), with the most pronounced changes in the dialysis subgroup. Metabolically, pCKD patients showed significantly decreased NAA/Cr in the basal ganglia and increased Cho/Cr in both the basal ganglia and pons (p < 0.01), alterations that were most severe in dialysis patients. Crucially, pontine metabolite ratios correlated strongly with brain volumes: NAA/Cr showed a significant negative correlation (p = 0.01), while Cho/Cr showed a significant positive correlation(p = 0.014). Metabolic basal ganglia changes remained statistically significant after covariation for grey matter volume (p ≤ 0.001).
CONCLUSION: In pediatric patients with moderate-to-severe CKD (stages 3-5), the disease is associated with widespread brain atrophy and region-specific metabolic alterations, which are exacerbated by dialysis. The observed correlation between pontine metabolite alterations and global brain volumes generates the hypothesis that brainstem pathology may reflect or contribute to brain volume changes. The combined use of volumetric MRI and MR spectroscopy provides a powerful, comprehensive biomarker for assessing CKD-related brain injury.
CLINICAL RELEVANCE STATEMENT: This study demonstrates that pediatric chronic kidney disease is associated with significant, measurable alterations in brain structure and metabolism. The findings underscore the necessity for integrating neurological surveillance into routine CKD management and establish a foundation for future trials to test neuroprotective strategies aimed at mitigating this previously underappreciated comorbidity.
引用
- Metwally MI, Eltohamy MF, Amin MI, et al. Impact of pediatric chronic kidney disease on brain integrity: A combined volumetric and MR spectroscopy analysis. Eur J Radiol. 2026. PMID: 42127649. doi:10.1016/j.ejrad.2026.112929
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。