磁共振R2^(*)法测量肝铁浓度对透析患者铁代谢评估的价值  

Value of MR R2^(*)measurement of liver iron concentration for assessing iron metabolism in patients with maintenance dialysis

作　　者：许星成 徐丽[1] 朱华夏 郭凯琦 马培旗 王仲秋 李小伟[1] XU Xingcheng;XU Li;ZHU Huaxia;GUO Kaiqi;MA Peiqi;WANG Zhongqiu;LI Xiaowei(Department of Nephrology,Fuyang People's Hospital of Anhui Medical University,Fuyang,Anhui 236000,China;不详)

机构地区：[1]安徽医科大学附属阜阳人民医院肾内科,安徽阜阳236000 [2]安徽医科大学附属阜阳人民医院影像科,安徽阜阳236000

出　　处：《中华全科医学》2024年第7期1162-1165,共4页Chinese Journal of General Practice

基　　金：安徽省重点研究与开发计划项目(2022e07020057);阜阳市第五期高层次创新创业领军人才项目(2020-04);阜阳市科技计划项目(FK202081049)。

摘　　要：目的使用磁共振R2^(*)法测量肝铁含量评估慢性肾脏病透析患者铁代谢状态并与传统血清学评价方法进行比较,探究磁共振R2^(*)法的价值。方法纳入2021年1月—2023年6月就诊于安徽医科大学附属阜阳人民医院39例慢性肾脏病维持性透析患者,应用磁共振测量肝脏R2^(*)值并计算肝铁浓度(LIC),将LIC与传统铁代谢评价指标铁蛋白、转铁蛋白饱和度等指标做相关分析,研究其对铁代谢评估的价值。结果39例慢性肾脏病透析患者中LIC缺乏组23例,占比59.0%,与LIC不缺乏组比较,LIC缺乏组患者肝R2^(*)值、铁蛋白降低,而总铁结合力、转铁蛋白、血红蛋白升高(P<0.05)。LIC与铁蛋白、红细胞分布宽度呈正相关关系,与总铁结合力、转铁蛋白呈负相关关系(r值分别为0.505、0.394、-0.392、-0.415,均P<0.05)。LIC分组标准与传统血清学分组标准诊断结果之间存在差异,差异有统计学意义(P<0.05)。依据2021年中国肾性贫血诊治临床实践指南标准,LIC缺乏组患者23例中不存在绝对性铁缺乏15例(65.2%),而LIC不缺乏组患者16例中存在绝对性铁缺乏3例(18.8%)。结论磁共振R2^(*)法测量LIC反映慢性肾脏病透析患者铁储存量,结合铁蛋白、转铁蛋白饱和度等指标可能有助于更好评价该类患者的铁代谢状态。Objective To evaluate the iron metabolism status of patients with chronic kidney disease undergoing dialysis by quantifying liver iron content using magnetic resonance R2^(*)imaging and to compare it with conventional serological assessment methods,thereby assessing the utility of the magnetic resonance R2^(*)method.Methods A cohort of 39 patients with chronic kidney disease undergoing dialysis,who visited Fuyang People's Hospital of Anhui Medical University between January 2021 and June 2023,was included.Magnetic resonance imaging was utilized to measure liver R2^(*)values and calculate liver iron concentration(LIC).Correlation analyses were conducted between LIC and traditional iron metabolism indicators such as ferritin and transferrin saturation to assess the role of LIC in iron metabolism evaluation.Results Among the 39 follow-up visits of patients with chronic kidney disease undergoing dialysis,23 cases(59.0%)were classified into the LIC deficiency group.Compared to the non-LIC deficiency group,the LIC deficiency group exhibited lower liver R2^(*),ferritin,while total iron binding capacity,transferrin,and hemoglobin levels were higher(P<0.05).LIC demonstrated a positive correlation with ferritin,and red blood cell distribution width,and negative correlations with total iron binding capacity,transferrin(r values of 0.505,0.394,-0.392,-0.415,all P<0.05).A significant difference was observed between the LIC grouping criteria and traditional serological grouping criteria(P<0.05).According to the 2021 Chinese Clinical Practice Guidelines for the Diagnosis and Treatment of Anemia in Renal Disease,among the 23 cases in the LIC deficiency group,15 cases(65.2%)did not have absolute iron deficiency,whereas among the 16 cases in the non-LIC deficiency group,3 cases(18.8%)had absolute iron deficiency.Conclusion The magnetic resonance R2^(*)method for measuring LIC provides insight into the iron storage of patients with chronic kidney disease undergoing dialysis,and when combined with indicators such as ferritin and tra

关 键 词：磁共振成像 R2^(*)法 铁代谢 慢性肾脏病 透析 

分 类 号：R459.5[医药卫生—治疗学] R445.2[医药卫生—临床医学]