长期输血患者心脏、肝脏铁负荷的评估及其与心功能关系的MR研究  

Assessment of myocardial and hepatic iron load and the correlation to cardiac function of patients with chronic blood transfusion by magnetic resonance imaging

作　　者：黄璐[1] 韩瑞[2] 王思勇[3] 廖茜[3] HUANG Lu;HAN Rui;WANG Siyong(Department of Radiology,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan,430030,China;Department of Radiology,Wuhan N0.1 Hospital,Wuhan,430022,China;Department of Radiology,the First Affiliated Hospital of Nanchang University,Nanchang,330006,China)

机构地区：[1]华中科技大学同济医学院附属同济医院放射科,武汉430030 [2]武汉市第一医院放射科,武汉430022 [3]南昌大学第一附属医院影像科,南昌330006

出　　处：《江西医药》2020年第4期370-373,377,共5页Jiangxi Medical Journal

基　　金：江西省卫生厅科技计划基金,编号20171043。

摘　　要：目的应用MR定量评价长期输血患者的心脏、肝脏沉积程度,并分析其与心功能参数之间的关系。方法收集长期输血患者25例(长期输血组),同时纳入年龄和性别匹配的健康志愿者22例作为正常对照组。所有入组对象均行1.5T磁共振检查,长期输血组中有16例仅行肝脏MRI扫描,余病例均行心肝MRI扫描。扫描序列包括左室连续短轴面稳态自由进动电影序列和T2*map序列以及肝横轴面T2*map序列,MR测量参数包括左、右心室心功能参数及左心室16个心肌节段T2*值和肝T2*值。长期输血组和对照组的比较采用独立样本t检验,心、肝T2*值和心功能参数的关系采用Pearson相关分析。结果25例长期输血组中有5例患者存在心肌铁过载,16例存在肝铁过载,9例未检出存在心、肝铁过载。长期输血组肝的T2*值与对照组比较有显著差异(P<0.001);较正常对照组,双心室的容积和射血分数、右心室心腔内径、左心室心肌壁厚度的差异不具有统计学意义(P>0.05)。左心室的收缩末期内径(LVESD)较对照组明显扩大(P=0.005);左心室心腔的缩短率(LVFS)较对照组明显减低(P=0.004)。LVESD能检出长期输血患者的早期心功能不全(AUC=0.83,P=0.009),且具有较高的敏感性(86%)和特异性(81%),而LVEF不能检出(AUC=0.61,P=0.381)。长期输血组心、肝T2*值与心功能参数无显著相关性(P>0.05),且心、肝T2*值也无显著相关性(r=0.231,P=0.277)。结论心、肝T2*值不能成为提示心功能异常的依据。LVESD有可能成为预测心肌铁超负荷患者心功能的新指标。Objective To evaluate myocardial and hepatic iron load of patients with chronic blood transfusion by MRI,and the relationship to cardiac function.Methods 25 patients with chronic blood transfusion(chronic transfusion group)were enrolled in this study,and 22 age and sex-matched healthy volunteer were enrolled as control group.All subjects underwent the examination in 1.5T MR scanner.In the chronic transfusion group,16 cases just underwent liver MR scanning,and the remaining underwent both of heart and liver MR scanning.The MR protocol included left ventricular(LV)short axis steady state free procession cine as T2*map,and axial T2*map of liver.Cardiac function parameters,myocardial T2*values of LV AHA 16 segments,and T2*values of liver were analyzed.The differences between chronic transfusion group and control group were calculated by independent sample t-test,and relationship between T2*values of heart and liver and cardiac function parameters were calculated by Pearson correlation analysis.Results Five chronic transfusion patients was detected as myocardial iron overload.Hepatic iron overload was found in 16 cases,but cardiac and hepatic iron overload was not detected in 9 cases.There was a significant difference of liver T2*values between chronic transfusion group and the controls(P<0.001).Compared to controls,biventricular ventricular volume as well as ejection fraction,RV dimensions and LV end-diastolic wall thickness showed no significant difference in chronic transfusion group(P>0.05).Left ventricular end-systolic dimension(LVESD)was significantly higher than the controls(P=0.005).Left ventricular fractional shortening(LVFS)was significantly lower than the controls(P=0.004).LVESD can detect early cardiac dysfunction of chronic transfusion patients(AUC=0.83,P=0.009)with a higher sensitivity(86%)and specificity(81%),while LVEF cannot identify it(AUC=0.61,P=0.381).There were no significant correlations between myocardial T2*and hepatic T2*(r=0.231,P=0.277),and also no significant correlations between cardiac fu

关 键 词：铁过载 心肌 肝脏 心功能 磁共振成像 

分 类 号：R445.2[医药卫生—影像医学与核医学]