MRI-T2*检测β-重型地中海贫血心、肝、胰铁沉积的临床价值

黄静文; 苏赟; 黎继昕; 杨绮华; 梁碧玲

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MRI-T2*检测β-重型地中海贫血心、肝、胰铁沉积的临床价值

临床研究 | 更新时间：2023-11-01

- MRI-T2*检测β-重型地中海贫血心、肝、胰铁沉积的临床价值
- Clinical Value of MRI T2* in Assessment of Myocardial, Hepatic and Pancreatic IronOverload in Thalassemia Major
- 中山大学学报（医学科学版） 2020年41卷第4期页码：611-619
- 作者机构：
  
  中山大学孙逸仙纪念医院放射科，广东广州 510120
- 作者简介：
  
  黄静文，硕士，住院医师，研究方向：儿科影像学，E-mail：huangjw25@mail2.sysu.edu.cn
- 基金信息：
  
  广东省自然科学基金(2018A0303130099);中山大学临床医学研究5010计划项目(2013014)
- DOI：
  中图分类号： R445.2
- 纸质出版日期：2020-07-15，
  
  收稿日期：2020-01-23，
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黄静文,苏赟,黎继昕等.MRI-T2*检测β-重型地中海贫血心、肝、胰铁沉积的临床价值[J].中山大学学报（医学科学版）,2020,41(04):611-619.

HUANG Jing-wen,SU Yun,LI Ji-xin,et al.Clinical Value of MRI T2* in Assessment of Myocardial, Hepatic and Pancreatic IronOverload in Thalassemia Major[J].Journal of Sun Yat-sen University(Medical Sciences),2020,41(04):611-619.
黄静文,苏赟,黎继昕等.MRI-T2*检测β-重型地中海贫血心、肝、胰铁沉积的临床价值[J].中山大学学报（医学科学版）,2020,41(04):611-619. DOI：

HUANG Jing-wen,SU Yun,LI Ji-xin,et al.Clinical Value of MRI T2* in Assessment of Myocardial, Hepatic and Pancreatic IronOverload in Thalassemia Major[J].Journal of Sun Yat-sen University(Medical Sciences),2020,41(04):611-619. DOI：

摘要

目的

MRI-T2*定量评价β-重型地中海贫血（β-TM）患者心肌、肝脏、胰腺铁沉积程度，探讨心肌铁沉积与肝脏、胰腺铁沉积的关系。

方法

回顾性分析2014年5月至2016年1月期间在我院行心脏、肝脏、胰腺MRI-T2*检查的109例β-TM患者的临床、实验室和MRI资料，采用Spearman相关性分析探讨心肌T2*值与肝脏、胰腺T2*值之间关系。将心肌、肝脏铁沉积的患者纳入A组（

=32），仅肝脏铁沉积、而心肌铁含量正常的患者纳入B组（

=69），将心肌、胰腺铁沉积的患者纳入C组（

=34），仅胰腺铁沉积、而心肌铁含量正常的患者纳入D组（

=58），采用两独立样本比较的Wilcoxon秩和检验比较A组与B组肝脏T2*、C组与D组胰腺T2*值的差异。绘制用肝脏、胰腺R2*（1/T2*）预测心肌铁沉积的ROC曲线。

结果

109例β-TM患者的心肌、肝脏、胰腺T2*中位数分别为27.7（3.2~45.4）ms 、1.8（0.7~18.6）ms及6.1（1.1~42.9）ms；诊断心肌铁沉积（T2*

20 ms）34例（31.2%），肝脏铁沉积（T2*

6.3 ms）101例（92.7%），胰腺铁沉积（T2*

26 ms）92例（84.4%）；诊断心肌铁沉积最小年龄7岁，肝脏和胰腺铁沉积最小年龄均为5岁。心肌T2*值与肝脏、胰腺T2*值均呈正相关（

分别为0.453、0.597

均

0.001）。A组肝脏T2*值低于B组（

=3.048，

=0.002），C组胰腺T2*值低于D组（

=6.682，

0.001）。肝脏、胰腺R2*（1/T2*）预测心肌铁沉积的ROC结果如下：曲线下面积分别为0.660（

=0.009）、0.933（

0.001），95%置信区间分别为 (0.543~0.777) 、(0.881~0.985)。

结论

β-TM患者肝脏、胰腺铁沉积的发生较早、且普遍，早于心肌铁沉积。肝脏、胰腺铁沉积与心肌铁沉积相关，两者结合可用于预测心肌铁沉积的情况。

Abstract

Objective

To quantify the myocardial

hepatic and pancreatic iron overload in β-thalassemia major (β-TM) using MRI T2* technique

and to analyze the relationship of iron deposition between the liver

pancreas and myocardium.

Methods

A total of 109 β-TM patients were enrolled in this retrospective study. Clinical and laboratory data were collected and patients were performed 1.5T T2* sequence MR scan on the heart

liver and pancreas. The spearman rank correlation was employed to analyze the relationship between liver T2*

pancreas T2* and myocardium T2*. Wilcoxon rank sum test was used to compare liver T2* values in the two groups: group A (

=32) with patients suffering from both myocardium iron overload (MIO) and liver iron overload (LIO)

group B (

=69) with patients suffering from LIO only. Wilcoxon rank sum test was used to compare pancreas T2* values in another two groups: group C (

=34) with patients suffering from both MIO and pancreas iron overload (PIO)

group D (

=58) with patients suffering from PIO only. Receiver operating characteristic (ROC) analysis was used to calculate the possibility of using hepatic and pancreatic iron as a predictor of myocardium iron deposition.

Results

The median T2* of myocardium

liver and pancreas of the 109 β-TM patients was 27.7 (3.2~45.4) ms

1.8 (0.7~18.6) ms

6.1 (1.1~42.9) ms

respectively. With the cut-off level of 20 ms

MIO was detected in 34 cases (31.2%)

the youngest one being 7 years old. With the cut-off level of 6.3 ms

LIO was detected in 101 cases (92.7%)

the youngest being 5 years old. With the cut-off level of 26 ms

PIO was detected in 92 cases (84.4%)

the youngest being 5 years old. Both liver T2*(

= 0.453

0.001) and pancreas T2* (

= 0.597

0.001) were positively correlated with myocardium T2*. Liver T2* values in group A were lower than those in group B (

=3.048，

=0.002). Pancreas T2* values in group C were lower than those in group D (

=6.682，

0.001). ROC analysis of liver and pancreas R2*(1/T2*) for diagnosing MIO revealed significant distinguishing power of liver R2*(

=0.009) and pancreas R2*(

0.001)

with area under the curve (AUC) of 0.660

0.933 and 95% confidence interval of 0.543-0.777

0.881-0.985

respectively.

Conclusions

Liver and pancreas iron overload occurr early and overwhelmingly in β-TM patients. Iron deposits earlier in the liver and pancreas than that in the myocardium. Both hepatic and pancreatic iron level are correlated with myocardial iron level

and can be predictors of the latter.

关键词

地中海贫血磁共振成像心肝胰腺铁

Keywords

thalassemiamagnetic resonance imagingheartliverpancreasiron

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