磁共振R2<sup>*</sup>法测量肝铁浓度对透析患者铁代谢评估的价值

许星成; 徐丽; 朱华夏; 郭凯琦; 马培旗; 王仲秋; 李小伟

doi:10.16766/j.cnki.issn.1674-4152.003590

磁共振R2^*法测量肝铁浓度对透析患者铁代谢评估的价值

doi: 10.16766/j.cnki.issn.1674-4152.003590

1.
安徽医科大学附属阜阳人民医院肾内科，安徽阜阳 236000
2.
安徽医科大学附属阜阳人民医院影像科

基金项目:

安徽省重点研究与开发计划项目 2022e07020057

阜阳市第五期高层次创新创业领军人才项目 2020-04

阜阳市科技计划项目 FK202081049

详细信息

通讯作者:
李小伟，E-mail: lllxxxwww2005@aliyun.com

中图分类号: R459.5 R445.2
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- 文章访问数: 15
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- PDF下载量: 1
- 被引次数: 0
出版历程
- 收稿日期: 2023-10-10
- 网络出版日期: 2024-09-05

Value of MR R2^* measurement of liver iron concentration for assessing iron metabolism in patients with maintenance dialysis

1.
Department of Nephrology, Fuyang People ' s Hospital of Anhui Medical University, Fuyang, Anhui 236000, China

摘要

摘要: 目的使用磁共振R2^*法测量肝铁含量评估慢性肾脏病透析患者铁代谢状态并与传统血清学评价方法进行比较，探究磁共振R2^*法的价值。方法纳入2021年1月—2023年6月就诊于安徽医科大学附属阜阳人民医院39例慢性肾脏病维持性透析患者，应用磁共振测量肝脏R2^*值并计算肝铁浓度(LIC)，将LIC与传统铁代谢评价指标铁蛋白、转铁蛋白饱和度等指标做相关分析，研究其对铁代谢评估的价值。结果 39例慢性肾脏病透析患者中LIC缺乏组23例，占比59.0%，与LIC不缺乏组比较，LIC缺乏组患者肝R2^*值、铁蛋白降低，而总铁结合力、转铁蛋白、血红蛋白升高(P < 0.05)。LIC与铁蛋白、红细胞分布宽度呈正相关关系，与总铁结合力、转铁蛋白呈负相关关系(r值分别为0.505、0.394、-0.392、-0.415，均P < 0.05)。LIC分组标准与传统血清学分组标准诊断结果之间存在差异，差异有统计学意义(P < 0.05)。依据2021年中国肾性贫血诊治临床实践指南标准，LIC缺乏组患者23例中不存在绝对性铁缺乏15例(65.2%)，而LIC不缺乏组患者16例中存在绝对性铁缺乏3例(18.8%)。结论磁共振R2^*法测量LIC反映慢性肾脏病透析患者铁储存量，结合铁蛋白、转铁蛋白饱和度等指标可能有助于更好评价该类患者的铁代谢状态。
- 磁共振成像 /
- R2^*法 /
- 铁代谢 /
- 慢性肾脏病 /
- 透析
Abstract: Objective To evaluate the iron metabolism status of patients with chronic kidney disease undergoing dialysis by quantifying liver iron content using magnetic resonance R2^* imaging and to compare it with conventional serological assessment methods, thereby assessing the utility of the magnetic resonance R2^* method. Methods A cohort of 39 patients with chronic kidney disease undergoing dialysis, who visited Fuyang People ' s Hospital of Anhui Medical University between January 2021 and June 2023, was included. Magnetic resonance imaging was utilized to measure liver R2^* values and calculate liver iron concentration (LIC). Correlation analyses were conducted between LIC and traditional iron metabolism indicators such as ferritin and transferrin saturation to assess the role of LIC in iron metabolism evaluation. Results Among the 39 follow-up visits of patients with chronic kidney disease undergoing dialysis, 23 cases (59.0%) were classified into the LIC deficiency group. Compared to the non-LIC deficiency group, the LIC deficiency group exhibited lower liver R2^*, ferritin, while total iron binding capacity, transferrin, and hemoglobin levels were higher (P < 0.05). LIC demonstrated a positive correlation with ferritin, and red blood cell distribution width, and negative correlations with total iron binding capacity, transferrin (r values of 0.505, 0.394, -0.392, -0.415, all P < 0.05). A significant difference was observed between the LIC grouping criteria and traditional serological grouping criteria (P < 0.05). According to the 2021 Chinese Clinical Practice Guidelines for the Diagnosis and Treatment of Anemia in Renal Disease, among the 23 cases in the LIC deficiency group, 15 cases (65.2%) did not have absolute iron deficiency, whereas among the 16 cases in the non-LIC deficiency group, 3 cases (18.8%) had absolute iron deficiency. Conclusion The magnetic resonance R2^* method for measuring LIC provides insight into the iron storage of patients with chronic kidney disease undergoing dialysis, and when combined with indicators such as ferritin and transferrin saturation, it may enhance the assessment of iron metabolism in these patients.
- Magnetic resonance imaging /
- R2^* method /
- Iron metabolism /
- Chronic kidney disease /
- Dialysis

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表 1 39例慢性肾脏病透析患者基线资料

Table 1. Baseline data of 39 dialysis patients with chronic kidney disease

项目	数据
透析龄[M(P₂₅, P₇₅)，月]	15.0(6.0，26.0)
血透[例(%)]	26(66.7)
腹透[例(%)]	13(33.3)
男性[例(%)]	26(66.7)
女性[例(%)]	13(33.3)
BMI[M(P₂₅, P₇₅)]	22.50(21.10, 24.90)
肝R2^*[M(P₂₅, P₇₅)，s^-1]	45.92(40.456, 62.998)
铁蛋白[M(P₂₅, P₇₅)，μg/L]	150.50(42.20, 226.70)
转铁蛋白饱和度[M(P₂₅, P₇₅)，%]	27.00(18.30, 36.80)
不饱和铁结合力[M(P₂₅, P₇₅)，μmol/L]	37.90(28.10, 44.50)
总铁结合力[M(P₂₅, P₇₅)，μmol/L]	50.70(43.50, 59.70)
转铁蛋白[M(P₂₅, P₇₅)，g/L]	2.00(1.80, 2.40)
血清铁[M(P₂₅, P₇₅)，μmol/L]	14.32(8.93, 16.74)
红细胞分布宽度[M(P₂₅, P₇₅)，fL]	46.80(44.20, 50.70)
肝脏铁浓度[M(P₂₅, P₇₅)，mg/g]	0.33(0.26, 0.58)
年龄[M(P₂₅, P₇₅)，岁]	42.00(33.00, 52.00)
血红蛋白(x±s，g/L)	100.95±18.46
LIC缺乏组[例(%)]	23(59.0)
红细胞分布宽度cv[M(P₂₅, P₇₅)，%]	13.60(13.00，14.50)
绝对性铁缺乏[例(%)]	11(28.2)
无绝对性铁缺乏[例(%)]	28(71.8)

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表 2 2组慢性肾脏病透析患者各指标比较

Table 2. Comparison of indicators between two groups of CKD dialysis patients

组别	例数	性别[例(%)]		铁蛋白 [M(P₂₅, P₇₅), μg/L]	不饱和铁结合 [M(P₂₅, P₇₅), μmol/L]	总铁结合力 [M(P₂₅, P₇₅), μmol/L]	肝铁浓度 [M(P₂₅, P₇₅), mg/g]	肝R2^* [M(P₂₅, P₇₅), s^-1]	体重指数 [M(P₂₅, P₇₅)]
组别	例数	男性	女性	铁蛋白 [M(P₂₅, P₇₅), μg/L]	不饱和铁结合 [M(P₂₅, P₇₅), μmol/L]	总铁结合力 [M(P₂₅, P₇₅), μmol/L]	肝铁浓度 [M(P₂₅, P₇₅), mg/g]	肝R2^* [M(P₂₅, P₇₅), s^-1]	体重指数 [M(P₂₅, P₇₅)]
LIC缺乏组	23	16(69.6)	7(30.4)	68.50(28.10, 199.20)	38.30(28.80, 48.00)	53.40(45.40, 63.40)	0.28(0.20, 0.30)	41.72(33.90, 43.80)	22.84(21.10, 25.30)
LIC不缺乏组	16	10(72.5)	6(37.5)	193.95(100.10, 319.10)	37.10(24.20, 39.70)	46.80(42.40, 50.50)	0.73(0.50, 1.30)	73.80(57.50, 115.20)	22.49(20.20, 24.20)
统计量		0.212^a		-2.199^b	-1.085^b	-2.042^b	-5.256^b	-5.254^b	-0.700^b
P值		0.645		0.028	0.278	0.041	< 0.001	< 0.001	0.484

组别	例数	转铁蛋白 [M(P₂₅, P₇₅), g/L]	红细胞分布宽度cv [M(P₂₅, P₇₅), %]	透析龄 [M(P₂₅, P₇₅), 月]	红细胞分布宽度 [M(P₂₅, P₇₅), fL]	转铁蛋白饱和度 [M(P₂₅, P₇₅), %]	血清铁 (x±s, μmol/L)	血红蛋白 (x±s, g/L)	年龄 (x±s, 岁)
LIC缺乏组	23	2.20(1.90, 2.50)	13.65(13.05, 14.65)	15.00(5.00, 27.00)	46.10(43.70, 47.40)	27.00(18.30, 36.50)	14.77±6.05	107.65±17.32	43.52±10.47
LIC不缺乏组	16	1.80(1.70, 2.00)	14.10(13.30, 14.80)	14.50(7.50, 18.00)	48.15(45.00, 54.00)	26.70(16.80, 45.00)	12.66±5.17	91.31±15.96	42.88±12.43
统计量		-2.222^b	-1.142^b	-0.029^b	-1.814^b	-0.357^b	1.136^c	2.991^c	0.176^c
P值		0.026	0.253	0.977	0.070	0.420	0.263	0.005	0.861
注：^a为χ²值，^b为Z值，^c为t值。

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表 3 慢性肾脏病透析患者LIC与血清学指标的相关性分析

Table 3. Correlation analysis between LIC and serological indicators in dialysis patients with chronic kidney disease

指标	r值	P值
铁蛋白	0.505	0.001
血红蛋白	-0.254	0.118
转铁蛋白饱和度	0.147	0.371
不饱和铁结合力	-0.293	0.070
总铁结合力	-0.392	0.014
转铁蛋白	-0.415	0.009
血清铁	-0.088	0.594
红细胞分布宽度	0.394	0.013
透析龄	0.295	0.219
体重指数	-0.219	0.180
红细胞分布宽度cv	-0.210	0.200

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表 4 LIC分组与依据血清铁蛋白及转铁蛋白饱和度分组比较(例)

Table 4. Comparision of LIC grouping and grouping based on serum ferritin and transferrin saturation levels(case)

LIC分组标准	传统血清学分组标准		总计
LIC分组标准	绝对性铁缺乏	无绝对性铁缺乏	总计
LIC缺乏	8	15	23
LIC不缺乏	3	13	16
总计	11	28	39
注：χ²=3.000，P=0.008。

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参考文献(20)

[1]	KHALIFA A, ROCKEY D C. The utility of liver biopsy in 2020[J]. Curr Opin Gastroenterol, 2020, 36(3): 184-191. doi: 10.1097/MOG.0000000000000621
[2]	MENESES A, SANTABÁRBARA J M, ROMERO J A, et al. Determination of non-invasive biomarkers for the assessment of fibrosis, steatosis and hepatic iron overload by MR image analysis. A pilot study[J]. Diagnostics (Basel), 2021, 11(7): 1178. DOI: 10.3390/diagnostics11071178.
[3]	白路天, 陆轶君, 张晓丽, 等. 慢性肾脏病患者铁过载的MRI定量研究[J]. 中国医学计算机成像杂志, 2023, 29(2): 167-172. doi: 10.3969/j.issn.1006-5741.2023.02.011 BAI L T, LU Y J, ZHANG X L, et al. Quantitative Assessment of Iron Overload in Patients with Chronic Kidney Disease using MRI Technique[J]. Chinese Computed Medical Imaging, 2023, 29(2): 167-172. doi: 10.3969/j.issn.1006-5741.2023.02.011
[4]	WANG Y, JU Y, AN Q, et al. Corrigendum: mDIXON-Quant for differentiation of renal damage degree in patients with chronic kidney disease[J]. Front Endocrinol, 2023, 14: 1267914. DOI: 10.3389/fendo.2023.1267914.
[5]	毕京凤, 刘欣瑶, 隋滨滨, 等. 磁共振定量成像测量肝脏R2^*值一致性研究[J]. 医学研究杂志, 2023, 52(5): 39-43. https://www.cnki.com.cn/Article/CJFDTOTAL-YXYZ202305009.htm BI J F, LIU X Y, SUI B B, et al. Consistency Study of Liver R2? Value Quantitative Measurements in High-field MRI[J]. Journal of Medical Research, 2023, 52(5): 39-43. https://www.cnki.com.cn/Article/CJFDTOTAL-YXYZ202305009.htm
[6]	中国医师协会肾脏内科医师分会肾性贫血指南工作组. 中国肾性贫血诊治临床实践指南[J]. 中华医学杂志, 2021, 101(20): 1463-1502. doi: 10.3760/cma.j.cn112137-20210201-00309 Working Group for Renal Anemia, Nephrology Branch of Chinese Medical Doctor Association. Clinical practice guidelines for the diagnosis and treatment of renal anemia in China[J]. National Medical Journal of China, 2021, 101(20): 1463-1502. doi: 10.3760/cma.j.cn112137-20210201-00309
[7]	王晓楠, 孙彤彤, 吴巧玲, 等. 采用MRI探究不同输血依赖性疾病患者肝脏铁过载及其影响因素[J]. 放射学实践, 2023, 38(6): 726-730. https://www.cnki.com.cn/Article/CJFDTOTAL-FSXS202306010.htm WANG X N, SUN T T, WU Q L, et al. Quantitative MRI analysis of liver iron content and its influencing factors in patients with different types of blood transfusion dependent diseases[J]. Radiologic Practice, 2023, 38(6): 726-730. https://www.cnki.com.cn/Article/CJFDTOTAL-FSXS202306010.htm
[8]	VENKATAKRISHNA S, OTERO H J, GHOSH A, et al. Rate of change of liver iron content by MR imaging methods: a comparison study[J]. Tomography, 2022, 8(5): 2508-2521. doi: 10.3390/tomography8050209
[9]	吕晴, 陈卫东, 刘磊. 维持性血液透析患者肾性贫血的多因素分析及相关性研究[J]. 中华全科医学, 2021, 19(5): 871-874. doi: 10.16766/j.cnki.issn.1674-4152.001938 LYU Q, CHEN W D, LIU L. Multivariate analysis and correlation study of anaemia in patients with maintenance haemodialysis[J]. Chinese Journal of General Practice, 2021, 19(5): 871-874. doi: 10.16766/j.cnki.issn.1674-4152.001938
[10]	陈吉林, 林洪丽. 慢性肾脏病患者铁缺乏及铁代谢[J]. 中国血液净化, 2020, 19(6): 368-371. doi: 10.3969/j.issn.1671-4091.2020.06.003 CHEN J L, LIN H L. Iron deficiency and iron metabolism in chronic kidney disease patients[J]. Chinese Journal of Blood Purification, 2020, 19(6): 368-371. doi: 10.3969/j.issn.1671-4091.2020.06.003
[11]	唐文娇, 廖若西. 肾性贫血铁剂治疗的研究进展[J]. 中国血液净化, 2023, 22(6): 438-441. doi: 10.3969/j.issn.1671-4091.2023.06.008 TANG W J, LIAO R X. Iron therapy for iron deficiency anemia in chronic kidney disease[J]. Chinese Journal of Blood Purification, 2023, 22(6): 438-441. doi: 10.3969/j.issn.1671-4091.2023.06.008
[12]	潘旭鸣, 陈丹垒, 楼群琪, 等. 维持性血液透析患者认知功能与血清炎症指标及脂联素水平的关系研究[J]. 浙江医学, 2023, 45(5): 464-469. https://www.cnki.com.cn/Article/CJFDTOTAL-ZJYE202305004.htm PAN X M, CHEN D L, LOU Q Q, et al. Association of cognitive function with serum inflammatory indicators and adiponectin levels in patients with maintenance hemodialysis[J]. Zhejiang Medical Journal, 2023, 45(5): 464-469. https://www.cnki.com.cn/Article/CJFDTOTAL-ZJYE202305004.htm
[13]	孙瑶, 吴建强. 血清铁蛋白在巨噬细胞活化综合征中作用的研究进展[J]. 浙江医学, 2021, 43(7): 797-800. https://www.cnki.com.cn/Article/CJFDTOTAL-ZJYE202107028.htm SUN Y, WU J Q. Advances in the role of serum ferritin in macrophage activation syndrome[J]. Zhejiang Medical Journal, 2021, 43(7): 797-800. https://www.cnki.com.cn/Article/CJFDTOTAL-ZJYE202107028.htm
[14]	REEDER S B, YOKOO T, FRANÇA M, et al. Quantification of liver iron overload with MRI: review and guidelines from the ESGAR and SAR[J]. Radiology, 2023, 307: e221856. DOI: 10.1148/radiol.221856.
[15]	BHIMANIYA S, ARORA J, SHARMA P, et al. Liver iron quantification in children and young adults: comparison of a volumetric multi-echo 3-D Dixon sequence with conventional 2-D T2^* relaxometry[J]. Pediatr Radiol, 2022, 52(8): 1476-1483. doi: 10.1007/s00247-022-05352-4
[16]	HENNINGER B, PLAIKNER M, ZOLLER H, et al. Performance of different Dixon-based methods for MR liver iron assessment in comparison to a biopsy-validated R2^* relaxometry method[J]. Eur Radiol, 2021, 31(4): 2252-2262. doi: 10.1007/s00330-020-07291-w
[17]	PICKLES E, KUMAR S, BRADY M, et al. Comparison of liver iron concentration calculated from R2^* at 1.5T and 3T[J]. Abdom Radiol (NY), 2023, 48(3): 865-873.
[18]	HERNANDO D, ZHAO R Y, YUAN Q, et al. Multicenter reproducibility of liver iron quantification with 1.5-T and 3.0-T MRI[J]. Radiology, 2023, 306(2): e213256. DOI: 10.1148/radiol.213256.
[19]	卢慧敏, 朱娟, 汪飞, 等. 磁共振R2^联合T1-mapping对肝脏铁过载评估的研究[J]. 医学影像学杂志, 2022, 32(8): 1306-1309. https://www.cnki.com.cn/Article/CJFDTOTAL-XYXZ202208009.htm LU H M, ZHU J, WANG F, et al. Study on R2 combined with T1-mapping to evaluate iron overload in liver[J]. Journal of Medical Imaging, 2022, 32(8): 1306-1309. https://www.cnki.com.cn/Article/CJFDTOTAL-XYXZ202208009.htm
[20]	LANSER L, PLAIKNER M, FAUSER J, et al. Tissue iron distribution in anemic patients with end-stage kidney disease: results of a pilot study[J]. J Clin Med, 2024, 13(12): 3487. DOI: 10.3390/jcm13123487.