Myocardial Iron Deficiency in Hemodialysis-Dependent End-Stage Renal Disease Patients Undergoing Oral Iron Therapy
Myocardial Iron Deficiency in Hemodialysis-Dependent End-Stage Renal Disease Patients Undergoing Oral Iron Therapy
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接受口服铁治疗的血液透析依赖性终末期肾病患者的心肌缺铁
DOI：
10.1016/j.jacc.2017.09.013
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发表时间：
2017
影响因子：
24
通讯作者：
Guo Ying-kun
中科院分区：
文献类型：
--
作者：
Xu Hua-yan;Yang Zhi-gang;Li Rui;Shi Ke;Zhang Yi;Li Zhen-lin;Xia Chun-chao;Peng Wan-lin;Chen Qing-yong;Guo Ying-kun
缺铁是血液透析依赖性终末期肾病（ESRD）患者最常见的并发症和贫血的主要原因。缺铁、心力衰竭、肾衰竭和贫血之间可能存在联系，称为心肾贫血缺铁综合征 (1)。纠正铁缺乏对于改善终末期肾病患者的贫血和降低心血管并发症的风险是必要的。口服铁剂疗法相对便宜且广泛使用，但使用口服铁剂的临床益处的证据有限且存在争议 (2)。临床上，由于血清铁蛋白 (SF) 易于使用和广泛使用，通常通过血清铁蛋白 (SF) 来确定缺铁，而储存水平通常根据肝脏铁含量来确定。然而，有证据表明，SF 和肝脏铁对于心脏等一些重要器官的组织铁来说是较差的指标 (3)。因此，对血液透析依赖性 ESRD 患者心肌铁水平的定量评估可能有助于铁管理，即使对于 SF 水平在正常范围内或高于正常范围的病例也是如此。在本研究中，我们旨在使用心脏磁共振 (CMR) T2* 映射评估服用口服铁剂的血液透析依赖性 ESRD 患者的心肌铁水平，并进一步确定 T2* 对左心室 (LV) 功能障碍的预测价值。我们纳入了 61 名 ESRD 患者（年龄 55.39±15.96 岁，23 名男性）和 29 名年龄和性别相似的正常对照受试者 我们机构的分布（年龄52.58±13.40岁，12名男性）。所有 ESRD 患者均接受定期透析（每周两次）和常规口服铁剂药物（多糖铁复合物，600 mg/天）治疗。 8个回波T2*源图像是在3.0-T磁共振扫描仪（Skyra， 德国埃尔兰根的西门子医疗解决方案），用于生成 T2* 图和值。使用离线软件（cmr42，Circle Cardioangiography Inc.，卡尔加里，艾伯塔省，加拿大）分析 LV T2 * 映射和功能。
Iron deficiency is the most common complication and the main cause of anemia in patients with hemodialysis-dependent end-stage renal disease (ESRD). There are possible relations among iron deficiency, cardiac failure, renal failure, and anemia, termed as the cardio-renal-anemia iron deficiency syndrome (1). Correction of this iron deficiency is necessary to improve anemia and reduce the risk of cardiovascular complications in patients with ESRD. Oral iron therapy is relatively inexpensive and widely used, but the evidence for the clinical benefits of using oral iron is limited and controversial (2). Clinically, iron deficiency is usually identified on serum ferritin (SF) because of its ease of use and wide availability, and stored levels are often determined on the liver iron content. However, there is evidence indicating that SF and liver iron are poor indicators for tissue iron in some vital organs such as the heart (3). Thus, quantitative assessment of myocardial iron levels in patients with hemodialysis-dependent ESRD may be useful for iron management, even for cases in which SF levels are within or higher than the normal range. In this study, we aimed to assess myocardial iron levels in patients with hemodialysis-dependent ESRD taking oral iron using cardiac magnetic resonance (CMR) T2* mapping, and further, to determine the predictive value of T2* for left ventricular (LV) dysfunction.We included 61 patients with ESRD (age 55.39±15.96 years, 23 men) and 29 normal control subjects with similar age and sex distributions (age 52.58±13.40 years, 12 men) in our institution. All patients with ESRD were treated with regular dialysis (twice weekly) and routine oral iron drugs (polysaccharide iron complex, 600 mg/day). The 8 echo T2* source images were obtained in a series of basal, middle, and apical short-axis slices (8 echoes, echo time range: 2.59 to 15.68 ms; repetition time: 816.40 ms; slice thickness: 8 mm; field of view: 357.50× 440.00 mm; flip angle: 40) on a 3.0-T magnetic resonance scanner (Skyra, Siemens Medical Solutions, Erlangen, Germany), and were used to generate the T2* map and values. LV T2* mapping and function were analyzed using offline software (cmr42, Circle Cardiovascular Imaging Inc., Calgary, Alberta, Canada).