采用MRI探究不同输血依赖性疾病患者肝脏铁过载及其影响因素  

Quantitative MRI analysis of liver iron content and its influencing factors in patients with different types of blood transfusion dependent diseases

作　　者：王晓楠[1] 孙彤彤 吴巧玲 赵明峰[4] 倪红艳[5] WANG Xiao-nan;SUN Tong-tong;WU Qiao-ling(The First Central Clinical School,Tianjin Medical University,Tianjin 300192,China)

机构地区：[1]天津医科大学一中心临床学院,天津300192 [2]北京积水潭医院放射科,北京102208 [3]中国医学科学院北京协和医院放射科,北京100730 [4]天津市第一中心医院血液科,天津300192 [5]天津市第一中心医院放射科,天津300192

出　　处：《放射学实践》2023年第6期726-730,共5页Radiologic Practice

基　　金：天津市卫生行业重点攻关课题基金资助项目(15KG134)。

摘　　要：目的:基于MRI R2*技术探究不同病种输血依赖性疾病患者肝脏铁过载情况及铁过载的影响因素。方法:前瞻性搜集输血依赖性疾病患者80例,其中18例再生障碍性贫血(AA),34例急性白血病(AL),28例骨髓增生异常综合征(MDS)。于3T MRI行多回波Dixon序列扫描,测量R2*值并计算肝脏铁含量(LIC)。搜集患者累计输血量及血清铁蛋白(SF)等临床资料并计算铁摄入量。比较不同病种间临床指标及LIC差异,分析LIC影响因素,并对SF与LIC、铁摄入量进行相关性分析。结果:单因素线性分析显示铁摄入量,病程和病种与LIC线性关系显著(P<0.01),多因素线性分析显示仅铁摄入量为LIC的影响因素(P<0.01)。所有患者SF与LIC及铁摄入量显著相关(r=0.480,P<0.01);AA、MDS组SF与LIC及铁摄入量之间均存在显著相关性(P<0.05),而AL组SF与LIC及铁摄入量无相关(P>0.05)。结论:不同输血依赖性疾病均存在肝脏铁沉积,病种间的铁代谢差异对肝脏铁负荷影响较小,可利用铁摄入量评估肝脏铁过载程度。Objective:To quantify the liver iron deposition and analyze the influencing factors of iron deposition in patients with different types of transfusion dependent diseases based on MRI R2*technology.Methods:Eighty patients with different types of transfusion dependent diseases were prospectively collected,including 18 cases of aplastic anemia(AA),34 cases of acute leukemia(AL),and 28 cases of myelodysplastic syndrome(MDS).Patients underwent multi-echo Dixon sequence scanning at 3T MRI to measure R2*values and calculate liver iron content(LIC)accordingly.Clinical data such as cumulative blood transfusion volumes and serum ferritin(SF)were recorded,and iron intake was calculated.The differences in clinical parameters and LIC in patients with different diseases were compared,the influencing factors of LIC were analyzed by linear regression,and the relationship between SF and LIC as well as iron intake was analyzed by correlation analysis.Results:Univariate linear analysis showed a significant linear relationship between iron intake,duration of disease,disease type and LIC(P=0.000),and multivariate linear analysis showed that only iron intake was a factor affecting LIC(P=0.000).The SF was significantly correlated with LIC and iron intake in all patients(P=0.000).There were significant correlations between SF and LIC as well as iron intake in the AA and MDS groups(P<0.05),while SF was not correlated with LIC and iron intake in the AL group(P>0.05).Conclusion:Liver iron deposition is present in different transfusion dependent diseases and the differences in iron metabolism among disease types have little effect on liver iron load,and the degree of liver iron overload can be assessed using iron intake.

关 键 词：输血 铁沉积 肝 磁共振成像 

分 类 号：R457.1[医药卫生—治疗学] R322.47[医药卫生—临床医学] R445.2