骨髓增生异常综合征患者铁代谢评估影响因素的回顾性研究  

Influencing factors of iron metabolism assessment in patients with myelodysplastic syndrome:A retrospective study

作　　者：张耀[1] 肖超[1] 李菁[1] 宋路茜[1] 赵幼山 赵俊功[1] 常春康[1] Zhang Yao;Xiao Chao;Li Jing;Song Luxi;Zhao Youshan;Zhao Jungong;Chang Chunkang(Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University,Shanghai 200233,China)

机构地区：[1]上海市第六人民医院,上海200233

出　　处：《中华血液学杂志》2022年第4期293-299,共7页Chinese Journal of Hematology

基　　金：国家自然科学基金(82070129)。

摘　　要：目的分析骨髓增生异常综合征(MDS)患者铁代谢评估的影响因素。方法181例MDS患者接受磁共振成像(MRI)和(或)能谱CT(DECT)对肝脏和心脏铁浓度的检测,其中41例患者在2次检查期间接受了规律铁螯合治疗(ICT)。同步检测调整铁蛋白(ASF)、红细胞生成素(EPO)、心功能、肝转氨酶、肝炎抗体、外周血T细胞极化等指标,并收集患者是否合并骨髓纤维化、脾大、环孢素A使用等信息进行比较分析。结果MRI组、DECT组肝铁浓度均与ASF呈正相关(r分别为0.512、0.606,P值均<0.001),MRI组心铁浓度与ASF仅呈弱相关(r=0.303,P<0.001),而DECT组心铁浓度与ASF无明显相关性(r=0.231,P=0.053)。输血依赖显著影响患者肝和心铁浓度[MRI组:LIC:(28.370±10.706)mg/g对(7.593±3.508)mg/g,t=24.30,P<0.001;MIC:1.81对0.95,z=2.625,P<0.05,DECT组:肝VIC:(4.269±1.258)g/L对(1.078±0.383)g/L,t=23.14,P<0.001:心VIC:1.69对0.68,z=3.142,P<0.05]。重度以上铁过载组患者EPO浓度明显高于轻中度铁过载组及正常组(P值均<0.001);MDS伴环状铁粒幼红细胞(MDS-RS)患者与和其他MDS低危组患者相比,肝铁浓度明显增高[DECT组:3.80(1.97,5.51)g/L对1.66(0.67,2.94)g/L,P=0.004;MRI组:13.7(8.1,29.1)mg/g对11.6(7.1,21.1)mg/g,P=0.032]。而年龄、骨髓纤维化、脾大、T细胞极化、环孢素A的使用、肝转氨酶、肝炎抗体阳性等因素对铁代谢无明显影响。结论MDS患者肝铁浓度与ASF呈正相关,心铁浓度与ASF无明显相关性。输血依赖、EPO浓度、合并RS是铁代谢的影响因素。Objective To analyze the influencing factors of iron metabolism assessment in patients with myelodysplastic syndrome.Methods MRI and/or DECT were used to detect liver and cardiac iron content in 181 patients with MDS,among whom,41 received regular iron chelation therapy during two examinations.The adjusted ferritin(ASF),erythropoietin(EPO),cardiac function,liver transaminase,hepatitis antibody,and peripheral blood T cell polarization were detected and the results of myelofibrosis,splenomegaly,and cyclosporine were collected and comparative analyzed in patients.Results We observed a positive correlation between liver iron concentration and ASF both in the MRI group and DECT groups(r=0.512 and 0.606,respectively,P<0.001),only a weak correlation between the heart iron concentration and ASF in the MRI group(r=0.303,P<0.001),and no significant correlation between cardiac iron concentration and ASF in the DECT group(r=0.231,P=0.053).Moreover,transfusion dependence in liver and cardiac[MRI group was significantly associated with the concentration of iron in:LIC:(28.370±10.706)mg/g vs(7.593±3.508)mg/g,t=24.30,P<0.001;MIC:1.81 vs 0.95,z=2.625,P<0.05;DECT group:liver VIC:(4.269±1.258)g/L vs(1.078±0.383)g/L,t=23.14,P<0.001:cardiac VIC:1.69 vs 0.68,z=3.142,P<0.05].The concentration of EPO in the severe iron overload group was significantly higher than that in the mild to moderate iron overload group and normal group(P<0.001).Compared to the low-risk MDS group,the liver iron concentration in patients with MDS with cyclic sideroblasts(MDS-RS)was significantly elevated[DECT group:3.80(1.97,5.51)g/L vs 1.66(0.67,2.94)g/L,P=0.004;MRI group:13.7(8.1,29.1)mg/g vs 11.6(7.1,21.1)mg/g,P=0.032].Factors including age,bone marrow fibrosis,splenomegaly,T cell polarization,use of cyclosporine A,liver aminotransferase,and hepatitis antibody positive had no obvious effect on iron metabolism.Conclusion There was a positive correlation between liver iron concentration and ASF in patients with MDS,whereas there was no significant correlatio

关 键 词：骨髓增生异常综合征 磁共振成像 能谱CT 铁过载 去铁治疗 

分 类 号：R551.3[医药卫生—血液循环系统疾病]