南方医科大学学报

南方医科大学学报 ›› 2013, Vol. 33 ›› Issue (02): 249-.

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磁共振成像（T2*）检测重型地中海贫血患者心脏、肝脏铁负荷及其临床意义

吴学东，井远方，裴夫瑜，陈佳奇，冯晓勤，何岳林，张玉明，李春富   

  • 出版日期:2013-02-20 发布日期:2013-02-20

Value of magnetic resonance imaging T2* tests in detecting heart and liver iron overload in patients with β-thalassemia major

  • Online:2013-02-20 Published:2013-02-20

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摘要： 目的联合血清铁蛋白、心脏及肝脏磁共振T2-star（T2*）评估重型β-地中海贫血（β-TM）患者的心脏、肝脏铁超负荷的临床
意义。方法南方医科大学南方医院输血+去铁治疗的β-TM中选择28例≥10岁，血清铁蛋白>1000 μg/L的患儿，2010~2011年
分批赴香港进行心脏T2*、肝脏T2*检测，检测结果分别与年龄、血清铁蛋白、左心室射血分数（LVEF）进行比较。结果14 例
（50%）发生心肌铁超负荷，其中心脏T2*<10 ms（重度）7 例，10~14 ms（中度）2 例，15~20 ms（轻度）5 例；肝脏铁过载28 例
（100%），其中2.7~6.3 ms（轻度）2例，1.4~2.7 ms（中度）7例，<1.4 ms（重度）19例；发生LVEF下降共2例（7.14%），其中1例患者
重度心肌铁超负荷；肝脏T2*与心脏T2*呈正相关（r=0.378，P=0.047），心脏T2*与血清铁蛋白呈负相关（r=-0.479，P=0.01），年龄
与血清铁蛋白、LVEF、心脏T2*、肝脏T2*均不相关。结论磁共振成像（T2*）是检测β-TM患者输血所致心脏、肝脏铁超负荷的
有效、无创的手段，联合血清铁蛋白可作为评估机体重要脏器铁过载的主要诊断指标。

Abstract: Objective To assess the value of magnetic resonance imaging T2* tests in the detection of myocardial and liver iron
overload in patients with β-thalassemia major (β-TM). Methods From 2010 to 2011, 28 β-TM patients over 10 years old under
blood transfusion therapy and chelation care with serum ferritin (SF) >1000 μg/L underwent myocardial and liver MRI T2*
tests on a voluntary basis. The results were analyzed in relation with age, SF, and left ventricular ejection fraction (LVEF).
Results Fourteen out of the 28 cases（50%）were found to have myocardial iron overload, including 7 severe cases, 2 moderate
cases, and 5 mild cases. All the 28 cases had liver iron overload, including 2 mild cases, 7 moderate cases, and 19 severe cases.
Two out of the 28 cases had lowered LVEF (7.14%), and one of them had severe myocardial iron overload. There was a negative
correlation between myocardial MRI T2* and SF (r=-0.479, P=0.01). Myocardial MRI T2* was positively correlated with liver
MRI T2* (r=0.378, P=0.047). Age was not significantly correlated with SF, LVEF, or liver MRI T2*. Conclusion Magnetic
resonance imaging (T2*) detection is an effective and non-invasive means for detecting myocardial and liver iron overload in
patients with β-thalassemia major receiving blood transfusion. T2* combined with SF is the main diagnostic indicator to assess
iron overload in the vital organs.