CAJ | 학술논문

目的探索磁共振成像技术(MRI)在铁过载患者诊断和随访中的应用.方法回顾性分析北京协和医院2011年7月至2014年3月临床上怀疑有铁过载的患者107例,通过MRI技术测定其肝脏、心脏及胰腺T2*值,同时检测了血清铁蛋白(SF)、转铁蛋白饱和度、输血量及其他实验室指标,比较脏器T2*值与SF、输血量的关系;对其中10例经过祛铁治疗的患者进行随访,探索治疗后SF及T2*值的改变.结果 ①男65例,女42例,中位年龄51(8～77)岁.诊断为骨髓增生异常综合征50例,再生障碍性贫血36例,骨髓纤维化10例,血色病7例,β地中海贫血携带者4例.②肝脏T2*值和SF之间呈低度相关(r=0.120,P=0.001),心脏T2*值与SF无相关性(r=0.012,P=0.289);肝脏和心脏T2*值均与输血量无相关性(分别为r=0.019,P=0.175;r=0.000,P=0.845);肝脏T2*值与心脏T2*值之间无相关性(r=0.015,P=0.235).③70例患者同时接受肝脏、心脏和胰腺T2*值检测,胰腺T2*值与SF呈低度相关(r=0.061,P=0.039),与输血量无相关性(r=0.000,P=0.960);胰腺T2*值与肝脏T2*值无相关性(r=0.047,P=0.071),而与心脏T2*值呈低度相关(r=0.110,P=0.005).④其中10例患者进行了规律足量祛铁治疗,治疗前、后SF水平明显下降,分别为(2 566.5±1 152.2) μg/L、(1 473.4±803.0) μg/L(P=0.001);治疗前、后肝脏T2*值变化不大,分别为(6.0±5.1)ms、(6.3±6.0)ms(P=0.629).结论各脏器铁过载的程度明显不同,MRI定量检测较SF更好地反映脏器间铁过载程度的差异;规律的祛铁治疗在半年内对SF的变化有显著影响,但对肝脏T2*值影响不大,可能需要更长时间的祛铁治疗才能观察到脏器铁沉积的改善.
목적 탐색자공진성상기술(MRI)재철과재환자진단화수방중적응용.방법 회고성분석북경협화의원2011년7월지2014년3월림상상부의유철과재적환자107례,통과MRI기술측정기간장、심장급이선T2*치,동시검측료혈청철단백(SF)、전철단백포화도、수혈량급기타실험실지표,비교장기T2*치여SF、수혈량적관계;대기중10례경과거철치료적환자진행수방,탐색치료후SF급T2*치적개변.결과 ①남65례,녀42례,중위년령51(8～77)세.진단위골수증생이상종합정50례,재생장애성빈혈36례,골수섬유화10례,혈색병7례,β지중해빈혈휴대자4례.②간장T2*치화SF지간정저도상관(r=0.120,P=0.001),심장T2*치여SF무상관성(r=0.012,P=0.289);간장화심장T2*치균여수혈량무상관성(분별위r=0.019,P=0.175;r=0.000,P=0.845);간장T2*치여심장T2*치지간무상관성(r=0.015,P=0.235).③70례환자동시접수간장、심장화이선T2*치검측,이선T2*치여SF정저도상관(r=0.061,P=0.039),여수혈량무상관성(r=0.000,P=0.960);이선T2*치여간장T2*치무상관성(r=0.047,P=0.071),이여심장T2*치정저도상관(r=0.110,P=0.005).④기중10례환자진행료규률족량거철치료,치료전、후SF수평명현하강,분별위(2 566.5±1 152.2) μg/L、(1 473.4±803.0) μg/L(P=0.001);치료전、후간장T2*치변화불대,분별위(6.0±5.1)ms、(6.3±6.0)ms(P=0.629).결론 각장기철과재적정도명현불동,MRI정량검측교SF경호지반영장기간철과재정도적차이;규률적거철치료재반년내대SF적변화유현저영향,단대간장T2*치영향불대,가능수요경장시간적거철치료재능관찰도장기철침적적개선.
Objective To use the technique of magnetic resonance imaging (MRI) T2* mapping to diagnose and follow-up of patients with iron overload.Methods 107 patients who were suspected to have iron overload between 2011.7-2014.3 in Peking Union Medical Colleague Hospital were analyzed retrospectively.Patients had the document of MRI T2* value of liver,heart and pancreas,serum ferritin (SF),transferrin saturation (TS),transfusion amount and other related laboratory tests.T2* values were compared with SF and transfusion amount.T2* values in different organs and their relationship with SF were also evaluated.10 patients who had been adequately chelated for more than half a year were followed up for their SF and T2* values.Results There were 65 males and 42 females with the median age of 51 (8-77)-year-old.They were 50 myelodysplastic syndromes (MDS),36 aplastic anemia,10 myelofibrosis,7 hemachromatosis and 4 thalassemia carriers.Liver T2* value was significantly related to SF (r=0.120,P=0.001),but not related to transfusion amount (r=0.019,P=0.175),whereas cardiac MRI T2* was not related either to SF or to transfusion amount.No correlation of the T2* value was found between liver and heart (r=0.015,P=0.235).70 patients was detected for liver,heart and pancreas T2* simultaneously.Pancreas T2* was compatible to SF (r=0.061,P=0.039) and cardiac T2* (r=0.110,P=0.005),but not correlated to heptic T2* (r=0.047,P=0.071) or transfusion amount (r=0.000,P=0.960).For the 10 wellchelated patients,during the half year follow-up period,SF changed significantly from (2 566.5± 1 152.2)μg/L before chelation to (1 473.4±803.0) μg/L after chelation (P=0.001),while liver T2* remained the same [(6.0±5.1) ms,(6.3±6.0) ms respectively,P=0.629].Conclusion MRI,although related to SF to some extent,was a valuable additional methods for quantifying iron overload.Iron deposition in different organs might be not related to each other and needed to be evaluated separately.Well-chelation therapy could change SF in half-year follow-up,but T2* change needed longer time to follow-up.