骨髓增生异常综合征患者铁代谢评估影响因素的回顾性研究

OBJECTIVE: To analyze the influencing factors of iron metabolism assessment in patients with myelodysplastic syndrome. METHODS: MRI and/or DECT were used to detect liver and cardiac iron content in 181 patients with MDS, among whom, 41 received regular iron chelation therapy during two examinations. The adjusted ferritin（ASF）, erythropoietin（EPO）, cardiac function, liver transaminase, hepatitis antibody, and peripheral blood T cell polarization were detected and the results of myelofibrosis, splenomegaly, and cyclosporine were collected and comparative analyzed in patients. RESULTS: We observed a positive correlation between liver iron concentration and ASF both in the MRI group and DECT groups（r＝0.512 and 0.606, respectively, P<0.001）, only a weak correlation between the heart iron concentration and ASF in the MRI group（r＝0.303, P<0.001）, and no significant correlation between cardiac iron concentration and ASF in the DECT group（r＝0.231, P＝0.053）. Moreover, transfusion dependence in liver and cardiac [MRI group was significantly associated with the concentration of iron in: LIC:（28.370±10.706）mg/g vs（7.593±3.508）mg/g, t＝24.30, P<0.001; MIC: 1.81 vs 0.95, z＝2.625, P<0.05; DECT group: liver VIC:（4.269±1.258）g/L vs（1.078±0.383）g/L, t＝23.14, P<0.001: cardiac VIC: 1.69 vs 0.68, z＝3.142, P<0.05]. The concentration of EPO in the severe iron overload group was significantly higher than that in the mild to moderate iron overload group and normal group（P<0.001）. Compared to the low-risk MDS group, the liver iron concentration in patients with MDS with cyclic sideroblasts（MDS-RS）was significantly elevated [DECT group: 3.80（1.97, 5.51）g/L vs 1.66（0.67, 2.94）g/L, P＝0.004; MRI group: 13.7（8.1,29.1）mg/g vs 11.6（7.1,21.1）mg/g, P＝0.032]. Factors including age, bone marrow fibrosis, splenomegaly, T cell polarization, use of cyclosporine A, liver aminotransferase, and hepatitis antibody positive had no obvious effect on iron metabolism. CONCLUSION: There was a positive correlation between liver iron concentration and ASF in patients with MDS, whereas there was no significant correlation between cardiac iron concentration and ASF. Iron metabolism was affected by transfusion dependence, EPO concentration, and RS.