重型β地中海贫血铁过载患儿心脏与肝脏磁共振T2*检测及其相关因素分析  

Detection of myocardial T2* and liver T2* in β-thalassemia major patients with iron overload and the analysis of related factors

作　　者：高红英[1] 陈光福[1] 陈娟娟[1] 

机构地区：[1]深圳市第二人民医院(深圳大学第一附属医院)儿科,广东深圳518035

出　　处：《中国实用儿科杂志》2011年第6期450-453,共4页Chinese Journal of Practical Pediatrics

基　　金：深圳市科技计划项目(No.200903051)

摘　　要：目的探讨重型β地中海贫血(β-TM)患儿心脏、肝脏铁过载状况,以及与临床监测指标之间的关系。方法 2010年6月,根据自愿的原则,从规律输血治疗的80例≥7岁的β-TM患儿中,选择51例,进行心脏磁共振T2*(心脏T2*)及肝脏磁共振T2*(肝脏T2*)检测。检测结果与年龄、血清铁蛋白(SF)、心脏左室射血分数(LVEF)、输血年限、去铁年限、输血前血红蛋白(Hb)进行比较。结果 51例患儿中11例(21.6%)发生心肌铁过载,其中轻度3例,中度3例,重度5例;肝脏铁过载43例(84.3%),其中轻度14例,中度17例,重度12例。心脏T2*与SF、LVEF、肝脏T2*之间无相关性,SF与肝脏T2*呈正相关(r=0.558,P<0.01)。心肌铁过载患儿输血年限大于心肌铁正常患儿(P<0.05),而肝脏铁过载发生率差异无统计学意义(P>0.05)。11例心肌铁过载患儿中,2例LVEF降低。结论β-TM患儿SF值可反映机体肝脏铁过载的情况,但不能预测心肌铁过载;随着输血年限的增加,心肌铁过载风险亦加大;心肌铁过载与肝脏铁过载之间存在着不一致性,肝脏铁过载不能成为提示心肌铁过载的依据。心肌铁过载患儿LVEF可以在正常范围,LVEF不能作为预测心肌铁过载的可靠指标。Objective To study the status of myocardial T2＊ and liver T2＊ in β- thalassemia major（β-TM） patients with iron overload and its relationship with clinical test data. Methods In June 2010, on a voluntary basis, out of the 80 β-TM patients over 7 years under regular blood transfusion therapy, 51 were chosen to receive myocardial MRI T2＊ （myocardial T2＊） and liver MRI T2＊ （liver T2＊） tests. The results were compared with age, SF, LVEF, transfusion time, ehelation time and Hb. Results Eleven out of 51 cases （21.6%） were myocardial iron overload,including 3 mild cases, 3 moderate cases and 5 severe cases. Forty-three out of 51 cases （84.3%） were liver iron overload,including 14 mild cases, 17 moderate cases and 12 severe cases. There was no correlation between myocardial T2＊ and SF, LVEF or liver T2＊. SF was positively correlated with liver T2＊ （r = 0.558, P 〈 0.01 ）. The transfusion time of myocardial T2＊ 〉 20 ms group was less than that of myocardial T2＊ 〈 20 ms group （P 〈 0.05）. There was no statistical significance between the liver iron overload ineidence ratios of the two groups （P 〉 0.05 ） . Two out of 11 myocardial iron overload cases had lower LVEF （18.2%）. Conclusion The group of TM patients demonstrates lower myocardial iron overload incidence and higher liver iron overload incidence. As SF increases, liver iron overload becomes more severe; myocardial iron overload can not be predicted or determined by examining SF level. There is no correlation between myocardial iron overload and liver iron overload. LVEF can not be a reliable factor to predict myocardial iron overload.

关 键 词：β-地中海贫血 重型 心肌铁过载 心脏磁共振 血清铁蛋白 左室射血分数 

分 类 号：R72[医药卫生—儿科]