目的探讨MRI-R2*定量评价肝铁超负荷患者去铁治疗疗效的价值。方法采用完全随机均衡设计法将24例铁超负荷患者分成2组,地拉罗司组和去铁胺组各12例。地拉罗司组和去铁胺组的剂量分别为40和50mg·kg-1·d-1,所有患者分别在治疗前及治疗后6和12个月行3次肝脏MR检查并测量R,’值。采用配对设计秩和检验分别比较2种药物治疗6及12个月后肝脏R2*值与治疗前的差异,并采用完全随机设计两样本秩和检验分别比较2组患者治疗6、12个月的肝脏R:。变化率(△R2*)及SF变化率(ASF)。结果地拉罗司组治疗前及治疗后6、12个月肝脏R2*值中位数分别为1081、889和712Hz,去铁胺组分别为1042、838和488Hz,治疗前2组患者肝脏R2*值间差异无统计学意义(Z=-0.029,P〉0.05)。地拉罗司治疗12个月的△R2*为-32%,去铁胺组为-58%,差异有统计学意义(Z=-3.060,P〈0.01)。ASF地拉罗司治疗12个月为-15%,去铁胺组为-55%,差异有统计学意义(Z=-2.945,P〈0.01)。结论MIRI-R2*技术能检测去铁疗效,去铁胺和地拉罗司都能有效去除肝铁,且去铁胺的去铁效能优于地拉罗司。
Objective To explore the value of MRI-R2 * and to compare clinical effect of two iron chelators ( deferasirox and deferoxamine) in iron-overloaded patients. Methods By completely randomized balanced design, 24 iron-overloaded patients were randomly divided into 2 groups, which consisted of 12 patients treated with deferasirox and 12 patients treated with deferoxamine. The planned deferasirox dose was 40 mg. kg-1 . d-1 , and the deferoxamine dose was no less than 50 mg. kg-1 . d-1. All patients underwent quantitative MRI at the time points of the primary screening, 6 months and 12 months. Pair Wilcoxon rank sum test was used to compare the differences of liver R2 * values of the 2 groups at various time points respectively. Wilcoxon rank sum test was used to compare the differences of change rate of liver R2* values between the two groups at the time point of 6 months, 12 months, respectively. Results Deferasirox group's liver R: * values of primary screening, 6 months and 12 months were 1081, 889 and 712 Hz, while deferoxamine group's liver R2 * values were 1042, 838 and 488 Hz. There was no statistically significant difference between liver R2 * values of two groups at primary screening ( Z = - 0. 029 ,P 〉 0. 05 ). The change rate of liver R2 * of deferasirox group at 12 month was - 32% , while it was - 58% for the deferoxamine group, and there was statistically significant difference between the two groups ( Z = - 3. 060, P 〈0. 01 ). The change rate of serum ferritin of deferasirox group at 12 month was - 15% , while it was -55% for the deferoxamine group, and there was statistically significant difference between the two groups (Z = -2. 945, P 〈 0.01 ). Conclusion By using MRI-R2*, it suggest that both deferasirox anddeferoxamine can effectively remove liver iron and deferoxamine is superior to deferasirox.