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Objective: To investigate the changes of insular functional connectivity in patients with uremic restless legs syndrome (uRLS) using seed-based resting-state functional connectivity analysis so as to explore the related risk factors for RLS. Methods: 3D high-resolution structural imaging was applied in 29 patients with uremic restless legs (uRLS group) and 29 healthy volunteers (control group) with maintenance hemodialysis. The greymatter volume of the insular cortex was assessed using a voxel-based morphometry (VBM) analysis and functional connectivity of insular variation was evaluated by a seed-based correlation analysis, while the seed was chosen as the significant difference of grey matter volume. Pearson correlation analysis was used to explore the significant correlation between functional connectivity and RLS score. The relationship between brain alterations and clinical variables were investigated with Logistic stepwise multiple regression analysis. Results: Compared with that in the control group, the area with reduced gray matter volume in the uRLS group was located on the left posterior insula (P<0.05, FWE correction). Taking the left post insular as a seed region, we further found reduced functional connectivity in patients mainly between the insular and primary sensorimotor cortex (S1), supplementary motor areas (SMA), and posterior mid-cingulate gyrus (P<0.05, FDR corrected). In uRLS group, the severity score of RLS was negatively correlated with insular-S1 functional connectivity (P<0.05, FDR corrected), while the hemoglobin level was negetively correlated with functional connectivity degree of insular-S1 (r=-0.449, P=0.015, FDR corrected). Conclusion: The altered morphology of the post insular cortex was revealed in uRLS patients. Abnormal sensorimotor activities in patients with RLS were closely associated with reduced functional connectivity of insular-S1. Low hemoglobin level was the most important risk factor for the abnormal functional connectivity of the brain.
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Objective: To explore the potential clinical risk factors related to abnormal microstructure of brain gray matter in end-stage renal disease (ESRD) patients with cognitive dysfunction. Methods: 3D high-resolution structural imaging was applied in 34 ESRD patients before hemodialysis and 34 health controls. We analyzed the characteristics of changes in gray matter cortical thickness in patients with ESRD before the first dialysis by surface based morphology (SBM) analysis. Further Pearson correlation analysis was used to reveal the relationship of the changed cortical thickness with the laboratory test indicators and clinical scale scores in patient group, with the covariants of age, sex and education removed. Results: Compared with that in control group, the broad cortex thickness decreases were observed in patients with ESRD before the first dialysis (P<0.01, FDR corrected), mainly including the bilateral postcentral gyrus, bilateral precentral gyrus, bilateral inferior parietal lobe (IPL), bilateral precuneus and some frontal and temporal lobes. Pearson correlation analysis showed that the cortical thickness in the IPL and precuneus had significantly negative correlation with uric acid level (r=-0.543, P<0.01) and the decreased thickness of bilateral IPL was positively related to AVL-IR score (right r=0.522, left r=0.649, P<0.01). Conclusion: ESRD patients showed extensive cortical thickness reduction before dialysis initiation, which corrected with overall cognition and immediate memory dysfunction. High uric acid level was the major factor of morphlolgical changes in ESRD patients before dialysis initiation.
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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.