目的 观察慢性肾脏病(chronic renal disease，CKD)患者进入血液透析治疗阶段前后的认知功能，及相关神经影像标志物改变，分析两者间关系。 方法 对40例CKD G5患者进行前瞻性队列随访，患者进入血液透析治疗阶段前和透析一年时分别完成实验室检测，蒙特利尔认知量表评估认知功能，及头磁共振扫描，使用动脉自旋标记和定量磁敏感成像观察双侧海马、丘脑、尾状核、壳核的脑血流量(cerebral blood flow，CBF)、磁敏感值。分析临床指标、认知功能、及上述感兴趣脑区的CBF、磁敏感值和CBF-磁敏感值耦合度变化，及认知功能与CBF-磁敏感值耦合度变化的关系。 结果 32例患者完成队列随访，血液透析治疗一年时，患者认知功能较前改善(Z=-3.266，P＜0.001)。较治疗前相比，左、右侧海马、右侧丘脑CBF降低(t/Z=2.192、2.616、2.488，P=0.036、0.009、0.018)，右侧尾状核CBF升高(Z=      -2.460，P=0.020)；左、右侧海马磁敏感值升高(Z=-3.983、-3.833，均P＜0.001)，左、右侧尾状核、左、右侧壳核磁敏感值降低(t/Z=4.352、2.165、3.810、3.665，P＜0.001、0.038、0.001、＜0.001)。左、右侧海马的CBF-磁敏感值耦合度明显提高(Z=-3.646、-4.600，均P＜0.001)，且认知功能改善与右侧海马的CBF-磁敏感值耦合度提高相关(r=0.431，P=0.014)。 结论 CKD患者进入血液透析治疗阶段一年时，部分脑区的CBF和磁敏感值及二者耦合度改变得到部分纠正，并与患者认知功能改善相关。

Objective  To observe cognitive function and changes in neuroimaging markers in patients with chronic kidney disease (CKD) before and after initiation of hemodialysis (HD), and to analyze the relationship between them. Methods  A prospective cohort study was conducted in 40 patients with stage 5 CKD. Laboratory tests, cognitive function assessment using the Montreal Cognitive Assessment (MoCA) scale, and brain magnetic resonance imaging (MRI) were performed before HD initiation and after 1 year of HD. Arterial spin labeling (ASL) and quantitative susceptibility mapping (QSM) were used to assess the cerebral blood flow (CBF) and susceptibility values in brain regions including the bilateral hippocampus, thalamus, caudate nucleus, and putamen. Changes in clinical indicators, cognitive function, as well as CBF, susceptibility values, and CBF- susceptibility coupling in the above-mentioned regions of interest before and after HD initiation were analyzed, and the relationship between cognitive function and CBF-susceptibility coupling was also explored. Results  32 patients completed the cohort follow-up of the study. After one year of HD treatment, cognitive function was significantly improved compared with t baseline (Z=-3.266, P＜0.001). Compared with the baseline, the CBF in the bilateral hippocampus and right thalamus decreased, while the CBF in the right caudate nucleus increased (t=2.192, P=0.036; Z=2.616, P=0.009; t=2.488, P=0.018; Z=-2.460, P=0.020); the susceptibility values in the bilateral hippocampus increased, and those in the bilateral caudate nucleus and bilateral putamen decreased (Z=-3.983, P＜0.001; Z=-3.833, P＜0.001; t=4.352, P＜0.001; t=2.165, P=0.038; t=3.810, P=0.001; Z=3.665, P＜0.001). More importantly, the CBF-susceptibility coupling in the bilateral hippocampus was significantly increased (Z=-3.646, P＜0.001; Z=-4.600, P＜0.001), and the improvement in cognitive function was correlated with an increase of CBF-susceptibility coupling in the right hippocampus (r=0.431, P=0.014).  Conclusion   After one year of HD, the changes in CBF, susceptibility values, and CBF-susceptibility coupling in some brain regions of CKD patients are partially reversed, which was associated with the improvement in cognitive function.