磁共振成像在骨髓增生异常综合征患者铁过载诊断和评估中的应用价值  

Study of iron overload assessment by T2^* magnetic resonance imaging in patients with myelodysplastic syndromes

作　　者：宋陆茜[1] 陆弘逾 肖超[1] 吴凌云[1] 吴东[1] 苏基滢[1] 周立宇 常春康[1] Song Luxi;Lu Hongyu;Xiao Chao;Wu Lingyun;Wu Dong;Su Jiying;Zhou Liyu;Chang Chunkang(Department of Hematology, Shanghai No.6 People’s Hospital Affiliated to Shanghai Jiaotong University, Shanghai 200233, China;Department of Hematology, Yangpu Hospital, Tongji University, Shanghai 200090, China)

机构地区：[1]上海交通大学附属第六人民医院血液科,200233 [2]同济大学附属杨浦医院血液科,上海200090

出　　处：《中华血液学杂志》2019年第3期222-226,共5页Chinese Journal of Hematology

摘　　要：目的探索MRI早期诊断和评估骨髓增生异常综合征(MDS)患者体内脏器铁过载的价值。方法以2014年11月至2018年1月期间接受过MRI横向弛豫时间(T2^*)检查(包括心和肝)的确诊为铁过载的85例MDS患者为研究对象,同时进行心脏超声检测获得左心室射血分数(LVEF),收集血清铁蛋白(SF)、肝脏谷丙转氨酶(ALT)、B型脑钠肽前体(proBNP)指标。其中有7例低/中危-1的MDS患者在2次MRI检查期间接受了规律去铁治疗6个月,除上述指标外,还收集去铁前后相应的外周血细胞计数、转铁蛋白饱和度(TS)、肝脏谷草转氨酶(AST)进行比较。结果研究对象心脏T2^*与年龄(rs=-0.290,P=0.007)、LVEF(rs=0.265,P=0.009)间存在相关性,其中有输血史的患者心脏T2^*与输血量呈明显负相关(rs=-0.701,P<0.001)。肝铁浓度(LIC)与SF呈显著的正相关(rs=0.577,P<0.001),LIC与ALT(rs=0.268,P=0.014)、输血量(rs=0.244,P=0.034)存在相关性。而心脏T2^*与proBNP、SF均无明显相关性(P值均>0.05),LIC与年龄也无明显相关性(P值均>0.05)。LVEF是否正常组间心脏T2^*值升高有统计学意义(P=0.005),但心脏铁过载比例(T2^*<20 ms)在两组中无统计学意义。ALT是否正常组间严重肝铁过载比例(LIC>15 mg/g DW)有统计学意义(P=0.045)。7例去铁治疗后患者SF、TS、ALT、AST、proBNP、LIC均比去铁治疗前降低,外周血细胞水平较治疗前升高。但LVEF和心脏T2^*去铁治疗后的改变不明显。结论心脏T2^*及LIC对MDS患者脏器铁过载评估有早期预测性,比同期的LVEF、SF及其他实验室指标更有价值,可作为脏器铁过载患者较为理想的早期检测和去铁治疗疗效评估手段。Objectives To analyze the cardiac T2^* value, liver iron concentration (LIC), and related laboratory parameters in myelodysplastic syndrome (MDS) with iron overload and evaluate the changes of organ functions after iron chelation therapy. To explore the value of magnetic resonance imaging (MRI) T2^* in making early diagnosis and assessing organs iron overload. Methods Retrospective investigation was used to observe the cardiac T2^* value, LIC, iron metabolism parameters and related laboratory parameters of 85 MDS patients from Nov 2014 to Jan 2018. Among them, 7 MDS patients with Low/Int-1 have received iron chelation therapy for 6 months during two MRI examinations. The above parameters were collected before and after iron chelation therapy for comparison. Results Correlations were found between heart T2^* value and age (rs=-0.290, P=0.007) and left ventricular ejection fraction (LVEF)(rs=0.265, P=0.009). There was a significant negative correlation between heart T2^* value and blood transfusion units (rs=-0.701, P<0.001). There was a significant positive correlation between LIC and serum ferritin (SF)(rs=0.577, P<0.001). There was also a correlation between LIC and ALT (rs=0.268, P=0.014) and blood transfusion units (rs=0.244, P=0.034). There was no correlation between heart T2^* and pro-BNP, SF (all P>0.05), and no correlation between LIC and age (P>0.05). The increase of heart T2^* between the normal and abnormal groups was statistically significant (P=0.005), but the iron overload ratio of the heart T2^*<20 ms was not significant between the two groups. There was statistical significance in the proportion of severe liver iron overload (LIC>15 mg/g DW)(P=0.045). After iron chelation therapy, the values of SF, transferrin saturation, ALT, AST, pro-BNP and LIC of 7 patients were decreased compared with values before iron chelation therapy, and the peripheral blood cell level was increased. However, the changes of LVEF and T2^* values after iron chelation were not obvious. Conclusion MRI T2^* may be a predictor

关 键 词：骨髓增生异常综合征 铁过载 磁共振成像 去铁治疗 

分 类 号：R551.3[医药卫生—血液循环系统疾病]