重型β地中海贫血患者肝脏胰腺和心脏铁负荷磁共振成像T2*的多中心研究

A multiple-center clinical study on quantitative T2* magnetic resonance imaging of iron deposition of liver,pancreas and heart of beta-thalassemia major patients

目的探讨使用磁共振成像T2*(MRI T2*)方法检测重型β地中海贫血(重型β地贫)患者肝脏、胰腺和心脏铁过载状况,并评估其有效性。方法总结2010年5月至2010年12月中国广东及广西省共7所医院的153例重型β地贫患者的临床资料,对其肝脏、胰腺、心脏MRI T2*与年龄、血清铁蛋白作相关性分析,并按肝脏不同铁沉积等级比较患者心脏和(或)胰腺铁沉积的情况。结果心脏铁沉积重度37例,轻度21例,正常95例。肝脏、胰腺和心脏MRI T2*值与血清铁蛋白水平有相关性,但与年龄无相关性,血清铁蛋白水平也与年龄无关。肝脏与胰腺T2*值(r=0.529,P=0.000)、肝脏与心脏的T2*值(r=0.369,P=0.000)以及胰腺与心脏T2*值(r=0.715,P=0.000)有相关性。随着肝脏铁沉积等级的增加,患者同时合并心和胰腺的比例也随之增大(χ2=20.78,P=0.000)。结论肝脏、胰腺、心脏三器官间的MRI T2*值有相关性。随着肝脏铁沉积等级增加,患者合并心脏、胰腺铁沉积的比例逐渐增高。

ObjectiveTo study the T2＊ magnetic resonance imaging for evaluation of iron deposition of liver,pancre-as and heart in β- thalassemia major（β-TM）patients and the relationship of the serum ferritin with iron overload.MethodsMeasurement of hepatic,pancreatic and cardiac MRI T2＊ was performed in 153 patients with β-TM fromMay 1,2010 to December 31,2010. The demographics and serum ferritin（SF）were collected. The rate of the ironoverload in liver,pancreas and heart was analyzed. The rates of combined pancreatic and cardiac iron overload in differ-ent hepatic iron overload groups were compared.ResultsAccording to MRI T2＊,there was serious hepatic iron over-load in 85 cases,moderate in 39,mild in 21,no iron overload in 8. Similarly,there was pancreatic iron overload in134,no iron overload in 19. In terms of cardiac iron overload,there was serious cardiac iron overload in 37 cases,mildin 21,no iron overload in 95. No correlation was found between hepatic,pancreatic and cardiac MRI T2＊ and age orSF,but hepatic MRI T2＊ correlated with pancreatic and cardiac MRI T2＊（P = 0.000,r = 0.529,r = 0.369）,and pan-creatic MRI T2＊ correlated with cardiac MRI T2＊ well（P = 0.000,r = 0.715）. As grade of hepatic iron over-load increases,the patients demonstrated higher rate ofcombination of pancreatic and cardiac iron overload si-multaneously（ χ2= 20.78, P = 0.000）.ConclusionThere are correlations among hepatic T2＊,pancreatic T2＊ and myocardial T2＊. The patients withβ-TM show higher rate of combined pancreatic and cardiaciron overload simultaneously with the increasing degree of hepatic iron overload.