磁共振成像(T2~*)检测重型地中海贫血患者心脏、肝脏铁负荷及其临床意义  

Value of magnetic resonance imaging T2~* tests in detecting heart and liver iron overload in patients with β-thalassemia major

作　　者：吴学东[1] 井远方[1] 裴夫瑜[1] 陈佳奇[1] 冯晓勤[1] 何岳林[1] 张玉明[1] 李春富[1] 

机构地区：[1]南方医科大学南方医院儿科,广东广州510515

出　　处：《南方医科大学学报》2013年第2期249-252,共4页Journal of Southern Medical University

基　　金：广东省科技计划项目(2011B031800280)

摘　　要：目的联合血清铁蛋白、心脏及肝脏磁共振T2-sta(rT2*)评估重型β-地中海贫血(β-TM)患者的心脏、肝脏铁超负荷的临床意义。方法南方医科大学南方医院输血+去铁治疗的β-TM中选择28例≥10岁,血清铁蛋白>1000μg/L的患儿,2010-2011年分批赴香港进行心脏T2*、肝脏T2*检测,检测结果分别与年龄、血清铁蛋白、左心室射血分数(LVEF)进行比较。结果 14例(50%)发生心肌铁超负荷,其中心脏T2*<10 ms(重度)7例,10-14 ms(中度)2例,15-20 ms(轻度)5例;肝脏铁过载28例(100%),其中2.7-6.3 ms(轻度)2例,1.4-2.7 ms(中度)7例,<1.4 ms(重度)19例;发生LVEF下降共2例(7.14%),其中1例患者重度心肌铁超负荷;肝脏T2*与心脏T2*呈正相关(r=0.378,P=0.047),心脏T2*与血清铁蛋白呈负相关(r=-0.479,P=0.01),年龄与血清铁蛋白、LVEF、心脏T2*、肝脏T2*均不相关。结论磁共振成像(T2*)是检测β-TM患者输血所致心脏、肝脏铁超负荷的有效、无创的手段,联合血清铁蛋白可作为评估机体重要脏器铁过载的主要诊断指标。Abstract： Objective To assess the value of magnetic resonance imaging T2＊ tests in the detection of myocardial and liver iron overload in patients with β-thalassemia major （β-TM）. Methods From 2010 to 2011, 28 β-TM patients over 10 years old under blood transfusion therapy and chelation care with serum ferritin （SF）〉1000 μg/L underwent myocardial and liver MRI T2＊ tests on a voluntary basis. The results were analyzed in relation with age, SF, and left ventricular ejection fraction （LVEF）. Results Fourteen out of the 28 cases（50%）were found to have myocardial iron overload, including 7 severe cases, 2 moderate cases, and 5 mild cases. All the 28 cases had liver iron overload, including 2 mild cases, 7 moderate cases, and 19 severe cases. Two out of the 28 cases had lowered LVEF （7.14%）, and one of them had severe myocardial iron overload. There was a negative correlation between myocardial MRI T2＊ and SF （r=-0.479, P=0.01）. Myocardial MRI T2＊ was positively correlated with liver MRI T2＊ （r=0.378, P=0.047）. Age was not significantly correlated with SF, LVEF, or liver MRI T2＊. Conclusion Magnetic resonance imaging （T2＊） detection is an effective and non-invasive means for detecting myocardial and liver iron overload in patients with β-thalassemia major receiving blood transfusion. T2＊ combined with SF is the main diagnostic indicator to assess iron overload in the vital organs.

关 键 词：重型Β-地中海贫血 血清铁蛋白 铁过载 心脏 肝脏 磁共振成像 左心室射血分数 

分 类 号：R445.2[医药卫生—影像医学与核医学] R556[医药卫生—诊断学]