Медицинская литература. Новинки

 

 

 

 

 

 

Показатели МСКТ и МРТ для оценки перегрузки железом и эффективности терапии перегрузки железом у пациентов с первичными и вторичными гемохроматозами

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Цель исследования: оценка параметров МРТ, МСКТ после проведения хелаторной, а также гемоэксфузионной терапии у пациентов с перегрузкой железа, выявление прогностической ценности показателей МСКТ в оценке среднетяжелой и тяжелой перегрузки железом.Материал и методы. Дизайн исследования – проспективное. В исследование включено 43 пациента с первичным (наследственным) гемохроматозом (НГХ) и вторичным трансфузионно-зависимым гемохроматозом (ВГ), получающих регулярные гемотрансфузии и терапию хелаторами железа. Проведена оценка возраста, частоты переливаний крови, используемого хелатирующего препарата. МСКТ выполнялась на двухэнергетическом компьютерном томографе Siemens Somatom Definition 128. До повторной МСКТ дошли 27 (62,8%) пациентов. МРТ проводили на высокопольном томографе Siemens Magnetom Espee с индукцией магнитного поля 1,5 Тл.Результаты. Медиана возраста – 34,00 [33,00; 53,50] года для НГХ и 52 [36,00; 62,00] года для ВГ. После терапии в общей группе значения T2* увеличились на 26%, LIC снизилась на 21,2%, ДЭРHU 140 и 80 mean на 17,6%, ДЭОHU 140 и 80 mean на 3%, ДЭИHU 140 и 80 mean на 92,8%, 80 max на 3%, ДЭРHU 140 и 80 max на 19%, ДЭО HU 140 и 80 max на 2,5% после терапии. У пациентов с НГХ Т2* печени увеличилось в 4,6 раза, LIC снизилась в 5,5 раза, ДЭРHU 140 и 80 mean на 35,1%, ДЭОHU 140 и 80 mean на 7,8%, ДЭИHU 140 и 80 mean на 93,6%, ДЭРHU 140 и 80 max на 29,3%, ДЭИHU 140 и 80 max на 21.6%. У пациентов ВГ LIC снизилась на 18,9%, ДЭИHU 140 и 80 mean на 92,2%. Значение 80 mean ? 85,5, значение 140 mean ? 71,5, значение М0,3 mean ? 76, значение ДЭИHU 140 и 80 mean ? 0,007996 и значение ДЭРHU 140 и 80 mean ? 18,5 предсказывают вероятность тяжелой перегрузки железом.Заключение. У пациентов после проведенной хелаторной терапии и терапии гемоэксфузиями снижаются показатели МРТ и МСКТ. Значения МСКТ 80 mean ? 85,5, 140 mean ? 71,5, М0,3 mean ? 76, ДЭИHU 140 и 80 mean ? 0,007996, ДЭРHU 140 и 80 mean ? 18,5 могут предсказывать значения LIC более 11 мг/г.

Ключевые слова:
LIC, ДЭИ, ДЭО, ДЭР, гемохроматоз, МСКТ, LIC, DEI, DER, DED, hemochromatosis, CT

Литература:
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MSCT and MRI indicators for assessing iron overload and the effectiveness of iron overload therapy in patients with primary and secondary hemochromatoses

Goal of research. Evaluation of MRI, CT parameters after chelation and hemoexfusion therapy in patients with iron overload, identification of the prognostic value of CT indicators in the assessment of moderate and severe iron overload.Materials and methods. The design of the study is prospective. The study included 43 patients with hereditary hemochromatosis (HH), secondary transfusion-dependent hemochromatosis (TDH) receiving regular hemotransfusions, iron chelators. We evaluated age, frequency of hemotransfusions, chelating drug used. CT was performed on a two-energy computer tomograph Siemens Somatom Definition 128. 27 patients (62.8%) reached repeated CT. MRI was performed on a Siemens Magnetom Espee high-field tomograph with a magnetic field induction of 1.5 T.Results. The median age was 34.00 [33.00; 53.50] for HH and 52 [36.00; 62.00] for TDH. After therapy in the general group, T2* values increased by 26%, LIC decreased by 21.2%, DEDHU 140 and 80 mean by 17.6%, DERHU 140 and 80 mean by 3%, DEIHU 140 and 80 mean by 92.8%, 80 max by 3%, DEDHU 140 and 80 max by 19%, DERHU 140 and 80 max by 2.5% after therapy. In patients with HH, liver T2* increased by 4.6 times, LIC decreased by 5.5 times, DEDHU 140 and 80 mean by 35.1%, DERHU 140 and 80 mean by 7.8%, DEIHU 140 and 80 mean by 93.6%, DEDHU 140 and 80 max by 29.3%, DEIHU 140 and 80 max by 21.6%. In patients with TDH, LIC decreased by 18.9%, DEIHU 140 and 80 mean by 92.2%. A value of 80 mean ? 85.5, 140 mean ? 71.5, M0.3 mean ? 76, DEIHU 140 and 80 mean ? 0.007996 and DEDHU 140 and 80 mean ? 18.5 predict the probability of severe iron overload.Conclusion. In patients after chelation therapy and hemoexfusion therapy, MRI and CT indicators decrease. The values of CT 80 mean ? 85.5, 140 mean ? 71.5, M0.3 mean ? 76, DEIHU 140 and 80 mean ? 0.007996, DEDHU 140 and 80 mean ? 18.5 can predict LIC values of more than 11 mg/g.

Keywords:
LIC, ДЭИ, ДЭО, ДЭР, гемохроматоз, МСКТ, LIC, DEI, DER, DED, hemochromatosis, CT