臺灣博碩士論文加值系統

本研究在藉由核磁共振影像，探討慢性腎病人腦部結構變化對認知功能退化的影響。許多文獻顯示，ESRD患者的認知障礙風險顯著高於一般人群，需要透過洗腎來排除體內的尿毒素。隨著腎功能的衰退，可能對腦部健康產生不利影響。可藉由此差異性了解兩者間腦部結構變化與認知功能之間的關係。本研究對象共49名，分為控制組、ESRD-無認知障礙組（ESRD-NonCI）和ESRD-有認知障礙組（ESRD-CI）。參與者均接受簡易心智量表（MMSE）、臨床失智評估量表（CDR）以及相關的血液檢測。數據分析顯示，控制組與ESRD-NonCI組的MMSE值無顯著差異，而ESRD-CI組的MMSE值顯著低於前兩組（p < 0.05），顯示ESRD患者的認知功能明顯下降。從腦部MRI影像結果顯示ESRD-CI組的腦容積較小，腦室擴大，進一步支持認知障礙與腦部結構變化之間的關聯。血液檢測結果顯示，IS和白蛋白（Alb）的水平在ESRD患者中普遍偏高，這些生化指標可能與認知功能的下降有關。研究結果顯示對ESRD患者進行定期認知評估和腦部監測的重要性。核磁共振影像也提供早期識別認知障礙標記的工具。提供醫療人員及時介入的時機，採取相應措施以改善患者未來的生活質量。這些發現也為未來的研究提供了方向，特別是預防和減緩認知功能退化方面。結論: ESRD患者腦部健康會受到多重因素的影響，包括腎功能衰退所引起的生化變化和腦部結構變化。這一研究不僅為臨床實踐提供了重要參考，可為相關領域的深入研究奠定基礎。希望未來能有更多的研究聚焦於ESRD患者的認知健康，以促進更全面的護理和管理策略。

The study investigates the relationship between brain tissue changes and cognitive function in patients with end-stage renal disease (ESRD). It highlights that ESRD patients are at a higher risk of cognitive impairment compared to the general population. The research involved 49 samples from ESRD patients and a control group, utilizing magnetic resonance imaging (MRI) to analyze brain structure. Participants were categorized into three groups: a control group, an ESRD group without cognitive impairment (ESRD-NonCI), and an ESRD group with cognitive impairment (ESRD-CI). Cognitive assessments were conducted using the Mini-Mental State Examination (MMSE) and the Clinical Dementia Rating Scale (CDR), along with blood tests for biochemical markers like serum urea nitrogen (IS) and albumin (Alb). The results showed no significant difference in MMSE scores between the control and ESRD-NonCI groups, while the ESRD-CI group had significantly lower scores. Additionally, the CDR results indicated a significant cognitive decline in the ESRD-CI group. The study found that higher brain volume ratios correlated with better cognitive function, while the ESRD-CI group exhibited more brain atrophy and enlarged ventricles. In conclusion, the findings suggest that structural brain changes in ESRD patients are linked to cognitive impairments, emphasizing the need for further research and potential interventions to address cognitive decline in this population.

目錄
誌 謝............ i
圖目錄 List of Figure... iv
表目錄 List of Table.... v
縮寫表 ................vi
摘要 ................vii
Abstract ........ix
第一章緒論 ........1
1.1大腦橫切面解剖........1
1.2 3D-slicer ........4
1.3文獻探討 ........5
1.4研究動機與目的 .......9
第二章 材料與方法....... 11
2.1研究對象 .......11
2.2核磁共振影像採集......11
2.3影像分析 ........12
2.4統計分析 ........14
第三章 結果 ........16
3.1研究樣本背景 ........16
3.2樣本血液生化檢驗各分組的差異... 17
3.3樣本認知障礙特性 ........19
3.4神經學生化檢驗(neurologic biomarkers)的各分組差異......20
3.5核磁共振影像的變異與影響 ........................21
3.5.1核磁共振影像之腦組織與腦白質病變(Brain tissue and Leukoarariosis)的變異 21
3.5.2核磁共振影像之腦室(Ventricle)的變異 ........22
3.5.3核磁共振影像之腦軟化(Encephalomalacia)的影響.25
3.5.4核磁共振影像之皮爾生(Pearson)相關係數比較 26
第四章 討論 ........31
第五章 結論 ........36
參考文獻 ................37
表圖 ................42-57

表目錄 List of Table
Table 1 Demographic and Clinical Characteristics of Study groups....... 42
Table 2 Comparison of Biochemical and hematologic parameters among three groups ........................................................................43
Table 3 Cognitive Assessment Scores in ESRD Patients with and without CI 44
Table 4 Comparison in certain brain biomarkers across three groups..... 45
Table 5 Comparison of Brain tissue and Leukoarariosis Volume and Surface Area in ESRD Patients With and Without CI...... ................................46
Table 6 Comparison of Ventricular Volume and Surface Area in Control, ESRD Patients with and without CI........................................... 47
Table 7 Comparison of Encephalomalacia Volume and Surface Area among Control, ESRD without and with CI Groups........................................ 48
Table 8 Pearson correlation association between brain structural characteristics and biological markers among groups.................................... 49
Table 9Pearson correlation association between brain structural characteristics and biomarkers among groups............................................ 50

圖目錄 List of Figure
Fig. 1 3D-Slicer 影像分析步驟:.................. 13
Fig. 2統計分析與作圖:........................... 15
Fig. 3 The Magnetic Resonance Imaging (MRI) on the right-hand side names the tissues........................................ 51
Fig. 4The 3D-slice view of the MRI image displays the parts of the brain. ................................................52
Fig. 5 The axial T2 flair of the MRI image in the 3D slicer view by using segmation...................................... 53
Fig. 6 The levels of Crintine.................. 54
Fig. 7 The Level of Indoxyl.................... 55
Fig. 8 Urea nitrogen (BUN)..................... 56
Fig. 9 The MMSE score.......................... 57

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