Abstract

目的分析骨髓增生异常综合征(MDS)患者铁代谢评估的影响因素。方法181例MDS患者接受磁共振成像(MRI)和(或)能谱CT(DECT)对肝脏和心脏铁浓度的检测,其中41例患者在2次检查期间接受了规律铁螯合治疗(ICT)。同步检测调整铁蛋白(ASF)、红细胞生成素(EPO)、心功能、肝转氨酶、肝炎抗体、外周血T细胞极化等指标,并收集患者是否合并骨髓纤维化、脾大、环孢素A使用等信息进行比较分析。结果MRI组、DECT组肝铁浓度均与ASF呈正相关(r分别为0.512、0.606,P值均<0.001),MRI组心铁浓度与ASF仅呈弱相关(r=0.303,P<0.001),而DECT组心铁浓度与ASF无明显相关性(r=0.231,P=0.053)。输血依赖显著影响患者肝和心铁浓度[MRI组:LIC:(28.370±10.706)mg/g对(7.593±3.508)mg/g,t=24.30,P<0.001;MIC:1.81对0.95,z=2.625,P<0.05,DECT组:肝VIC:(4.269±1.258)g/L对(1.078±0.383)g/L,t=23.14,P<0.001:心VIC:1.69对0.68,z=3.142,P<0.05]。重度以上铁过载组患者EPO浓度明显高于轻中度铁过载组及正常组(P值均<0.001);MDS伴环状铁粒幼红细胞(MDS-RS)患者与和其他MDS低危组患者相比,肝铁浓度明显增高[DECT组:3.80(1.97,5.51)g/L对1.66(0.67,2.94)g/L,P=0.004;MRI组:13.7(8.1,29.1)mg/g对11.6(7.1,21.1)mg/g,P=0.032]。而年龄、骨髓纤维化、脾大、T细胞极化、环孢素A的使用、肝转氨酶、肝炎抗体阳性等因素对铁代谢无明显影响。结论MDS患者肝铁浓度与ASF呈正相关,心铁浓度与ASF无明显相关性。输血依赖、EPO浓度、合并RS是铁代谢的影响因素。

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