• 四川大學(xué)華西醫(yī)院放射科（四川成都 610041）;

目的 　總結(jié)不同測定人體鐵含量的方法及其應(yīng)用。
方法 　通過復(fù)習(xí)國內(nèi)外相關(guān)文獻，分析測定人體鐵含量的方法以及各自的優(yōu)缺點。
結(jié)果 　測定人體鐵含量的方法主要有實驗室檢查、病理學(xué)檢查、CT檢查、超導(dǎo)量子干涉設(shè)備（SQUID）及MRI。
結(jié)論 　血清學(xué)檢查是最簡單和經(jīng)濟的體內(nèi)鐵含量的測定方法，經(jīng)皮肝臟穿刺活檢依然是測量肝臟鐵含量（LIC）的金標(biāo)準(zhǔn)，影像學(xué)檢查，尤其是MRI有望成為LIC測定的主要方法。

引用本文： 劉丹,宋彬,袁放,唐鶴涵. 人體鐵含量的測定方法及其應(yīng)用. 中國普外基礎(chǔ)與臨床雜志, 2012, 19(12): 1347-1351. doi: 復(fù)制

1. Borgna-Pignatti C， Castriota-Scanderbeg A. Methods for evaluatingiron stores and efficacy of chelation in transfusional hemosiderosis[J]. Haematologica， 1991， 76(5)：409-413.
2. Batts KP. Iron overload syndromes and the liver[J]. Mod Pathol， 2007， 20(1)： 31-39.
3. Hentze MW， Muckenthaler MU， Andrews NC. Balancing acts：molecular control of mammalian iron metabolism[J]. Cell， 2004， 117(3)： 285-297.
4. Rund D， Rachmilewitz E. Beta-thalassemia[J]. N Engl J Med， 2005， 353(11)： 1135-1146.
5. Guyader D， Gandon Y. Quantification of iron overload[J]. Bull Acad Natl Med， 2000， 184(2)：337-347.
6. Pakbaz Z， Fischer R， Fung E， et al. Serum ferritin underestimates liver iron concentration in transfusion independent thalassemia patients as compared to regularly transfused thalassemia and sickle cell patients[J]. Pediatr Blood Cancer， 2007， 49(3)：329-332.
7. Angelucci E， Barosi G， Camaschella C， et al. Italian Society of Hematology practice guidelines for the management of iron overload in thalassemia major and related disorders[J]. Haematologica， 2008， 93(5)： 741-752.
8. Imbert-Bismut F， Charlotte F， Turlin B， et al. Low hepatic iron concentration：evaluation of two complementary methods，colorimetric assay and iron histological scoring[J]. J Clin Pathol， 1999， 52(6)： 430-434.
9. Angelucci E， Brittenham GM， McLaren CE， et al. Hepatic iron concentration and total body iron stores in thalassemia major[J]. N Engl J Med， 2000， 343(5)：327-331.
10. Barry M. Liver iron concentration， stainable iron， and total body storage iron[J]. Gut， 1974， 15(5)： 411-415.
11. Valberg LS， Simon JB， Manley PN， et al. Distribution of storage iron as body stores expand in patients with hemochromatosis[J]. J Lab Clin Med， 1975， 86(3)：479-489.
12. Bassett ML， Halliday JW， Powell LW. Value of hepatic iron measurements in early hemochromatosis and determination of the critical iron level associated with fibrosis[J]. Hepatology， 1986， 6(1)：24-29.
13. Deugnier YM， Turlin B， Powell LW， et al. Differentiationbetween heterozygotes and homozygotes in genetic hemochromatosis by means of a histological hepatic iron index：a study of 192 cases[J]. Hepatology， 1993， 17(1)：30-34.
14. Scheuer PJ， Williams R， Muir AR. Hepatic pathology in relativesof patients with hemochromatosis[J]. J Pathol Bacteriol， 1962， 84：53-64.
15. Ludwig J， Batts KP， Moyer TP， et al. Liver biopsy diagnosis of homozygous hemochromatosis： a diagnostic algorithm[J]. Mayo Clin Proc， 1993， 68(3)：263-267.
16. Deugnier YM， Loréal O， Turlin B， et al. Liver pathology in genetic hemochromatosis：a review of 135 homozygous cases and their bioclinical correlations[J]. Gastroenterology， 1992， 102(6)：2050-2059.
17. Ludwig J， Hashimoto E， Porayko MK， et al. Hemosiderosis in cirrhosis：a study of 447 native livers[J]. Gastroenterology， 1997， 112(3)：882-888.
18. Guyader D， Gandon Y， Deugnier Y， et al. Evaluation of computedtomography in the assessment of liver iron overload：a study of 46 cases of idiopathic hemochromatosis[J]. Gastroenterology， 1989， 97(3)： 737-743.
19. Howard JM， Ghent CN， Carey LS， et al. Diagnostic efficacy of hepatic computed tomography in the detection of body iron overload[J]. Gastroenterology， 1983， 84(2)：209-215.
20. Houang MT， Arozena X， Skalicka A， et al. Correlation between computed tomographic values and liver iron content in thalassaemia major with iron overload[J]. Lancet， 1979， 1(8130)： 1322-1323.
21. Goldberg HI， Cann CE， Moss AA， et al. Noninvasive quantitation of liver iron in dogs with hemochromatosis using dual-energy CT scanning[J]. Invest Radiol， 1982， 17(4)：375-380.
22. Fischer MA， Reiner CS， Raptis D， et al. Quantification of liver iron content with CT-added value of dual-energy[J]. Eur Radiol，2011， 21(8)： 1727-1732.
23. Goldman IS， Winkler ML， Raper SE， et al. Increased hepatic density and phospholipidosis due to amiodarone[J]. AJR Am J Roentgenol， 1985， 144(3)：541-546.
24. De Maria M， De Simone G， Laconi A， et al. Gold storage in the liver：appearance on CT scans[J]. Radiology， 1986， 159(2)：355-356.
25. Gomori JM， Horev G， Tamary H， et al. Hepatic iron overload：quantitative MR imaging[J]. Radiology， 1991， 179(2)：367-369.
26. Farrell DE， Tripp JH， Zanzucchi PE， et al. Magnetic measurement of human iron stores[J]. IEEE Trans Magnetics， 1980， 16(5)： 818-823.
27. Brittenham GM， Farrell DE， Harris JW， et al. Magnetic-susceptibility measurement of human iron stores[J]. N Engl J Med， 1982， 307(27)： 1671-1675.
28. Sheth S. SQUID biosusceptometry in the measurement of hepatic iron[J]. Pediatr Radiol， 2003， 33(6)： 373-377.
29. Nielsen P， Engelhardt R， Düllmann J， et al. Non-invasive liver iron quantification by SQUID-biosusceptometry and serum ferritiniron as new diagnostic parameters in hereditary hemochromatosis[J]. Blood Cells Mol Dis， 2002， 29(3)： 451-458.
30. Fischer R， Tiemann CD， Engelhardt R， et al. Assessment of iron stores in children with transfusion siderosis by biomagnetic liver susceptometry[J]. Am J Hematol， 1999， 60(4)：289-299.
31. Fischer R， Piga A， Harmatz P， et al. Monitoring long-termefficacy of iron chelation treatment with biomagnetic liver susceptometry[J]. Ann N Y Acad Sci， 2005， 1054： 350-357.
32. Idbaih A， Boukobza M， Crassard I， et al. MRI of clot in cerebralvenous thrombosis：high diagnostic value of susceptibility-weighted images[J]. Stroke， 2006， 37(4)：991-995.
33. Nielsen P， Engelhardt R， Duerken M， et al. Using SQUID biomagnetic liver susceptometry in the treatment of thalassemia and other iron loading diseases[J]. Transfus Sci， 2000， 23(3)：257-258.
34. Gandon Y， Olivié D， Guyader D， et al. Non-invasive assessment of hepatic iron stores by MRI[J]. Lancet， 2004， 363(9406)：357-362.
35. Jensen PD. Evaluation of iron overload[J]. Br J Haematol， 2004， 124(6)：697-711.
36. Jensen PD， Jensen FT， Christensen T， et al. Non-invasiveassessment of tissue iron overload in the liver by magnetic resonanceimaging[J]. Br J Haematol， 1994， 87(1)： 171-184.
37. Bonkovsky HL， Rubin RB， Cable EE， et al. Hepatic ironconcentration：noninvasive estimation by means of MR imaging techniques[J]. Radiology， 1999， 212(1)： 227-234.
38. Papakonstantinou OG， Maris TG， Kostaridou V， et al. Assessment of liver iron overload by T2-quantitative magnetic resonance imaging：correlation of T2-QMRI measurements with serumferritin concentration and histologic grading of siderosis[J]. Magn Reson Imaging， 1995， 13(7)： 967-977.
39. Anderson LJ， Holden S， Davis B， et al. Cardiovascular T2-star (T2*) magnetic resonance for the early diagnosis of myocardial iron overload[J]. Eur Heart J， 2001， 22(23)： 2171-2179.
40. Ernst O， Sergent G， Bonvarlet P， et al. Hepatic iron overload：diognosis and quantification with MR imaging[J]. AJR Am J Roentgenol， 1997， 168(5)：1205-1208.
41. Queiroz-Andrade M， Blasbalg R， Ortega CD， et al. MR Imagingfindings of iron overload[J]. Radiographics， 2009， 29(6)：1575-1589.
42. Tziomalos K， Perifanis V. Liver iron content determination by magnetic resonance imaging[J]. World J Gastroenterol， 2010， 16(13)： 1587-1597.
43. Westwood M， Anderson LJ， Firmin DN， et al. A single breath-hold multiecho T2* cardiovascular magnetic resonance technique for diagnosis of myocardial iron overload[J]. J Magn Reson Imaging， 2003， 18(1)：33-39.
44. Hankins JS， McCarville MB， Loeffler RB，et al. R2* magnetic resonance imaging of the liver in patients with iron overload[J]. Blood， 2009， 113(20)：4853-4855.
45. Wood JC， Enriquez C， Ghugre N， et al. MRI R2 and R2* mappingaccurately estimates hepatic iron concentration in transfusion-dependent thalassemia and sickle cell disease patients[J]. Blood， 2005， 106(4)：1460-1465.
46. St Pierre TG， Clark PR， Chua-Anusorn W. Single spin-echo protontransverse relaxometry of iron loaded-liver[J]. NMR Biomed，2004， 17(7)： 446-458.
47. Argyropoulou MI， Astrakas L. MRI evaluation of tissue iron burdenin patients with beta-thalassaemia major[J]. Pediatr Radiol， 2007， 37(12)： 1191-1200.
48. Haacke EM， Reichenbach JR. Susceptibility weighted imaging in MRI：basic concepts and clinical applications[M]. Hoboken， New Jersey：John Wiley&Sons， 2011：10.
49. Angelucci E， Giovagnoni A， Valeri G， et al. Limitations of magnetic resonance imaging in measurement of hepatic iron[J]. Blood， 1997， 90(12)： 4736-4742.
50. Reichenbach JR， Venkatesan R， Schillinger DJ， et al. Small vesselsin the human brain：MR venography with deoxyhemoglobin as an intrinsic contrast agent[J]. Radiology， 1997， 204(1)：272-277.
51. Haacke EM， Xu Y， Cheng YC， et al. Susceptibility weighted imaging (SWI)[J]. Magn Reson Med， 2004， 52(3)： 612-618.
52. Dai Y， Zeng M， Li R， et al. Improving detection of siderotic nodules in cirrhotic liver with a multi-breath-hold susceptibility weighted imaging technique[J]. J Magn Reson Imaging， 2011， 34(2)： 318-325.
53. Tao R， Zhang J， Dai Y， et al. An in vitro and in vivo analysisof the correlation between susceptibility-weighted imaging phase values and R2* in cirrhotic livers[J]. PLoS One， 2012， 7(9)： e45477.
54. Haacke EM， Miao Y， Liu M， et al. Correlation of putative iron content as represented by changes in R2* and phase with age in deep gray matter of healthy adults[J]. J Magn Reson Imaging， 2010， 32(3)： 561-576.
  1. 1. Borgna-Pignatti C， Castriota-Scanderbeg A. Methods for evaluatingiron stores and efficacy of chelation in transfusional hemosiderosis[J]. Haematologica， 1991， 76(5)：409-413.
  2. 2. Batts KP. Iron overload syndromes and the liver[J]. Mod Pathol， 2007， 20(1)： 31-39.
  3. 3. Hentze MW， Muckenthaler MU， Andrews NC. Balancing acts：molecular control of mammalian iron metabolism[J]. Cell， 2004， 117(3)： 285-297.
  4. 4. Rund D， Rachmilewitz E. Beta-thalassemia[J]. N Engl J Med， 2005， 353(11)： 1135-1146.
  5. 5. Guyader D， Gandon Y. Quantification of iron overload[J]. Bull Acad Natl Med， 2000， 184(2)：337-347.
  6. 6. Pakbaz Z， Fischer R， Fung E， et al. Serum ferritin underestimates liver iron concentration in transfusion independent thalassemia patients as compared to regularly transfused thalassemia and sickle cell patients[J]. Pediatr Blood Cancer， 2007， 49(3)：329-332.
  7. 7. Angelucci E， Barosi G， Camaschella C， et al. Italian Society of Hematology practice guidelines for the management of iron overload in thalassemia major and related disorders[J]. Haematologica， 2008， 93(5)： 741-752.
  8. 8. Imbert-Bismut F， Charlotte F， Turlin B， et al. Low hepatic iron concentration：evaluation of two complementary methods，colorimetric assay and iron histological scoring[J]. J Clin Pathol， 1999， 52(6)： 430-434.
  9. 9. Angelucci E， Brittenham GM， McLaren CE， et al. Hepatic iron concentration and total body iron stores in thalassemia major[J]. N Engl J Med， 2000， 343(5)：327-331.
  10. 10. Barry M. Liver iron concentration， stainable iron， and total body storage iron[J]. Gut， 1974， 15(5)： 411-415.
  11. 11. Valberg LS， Simon JB， Manley PN， et al. Distribution of storage iron as body stores expand in patients with hemochromatosis[J]. J Lab Clin Med， 1975， 86(3)：479-489.
  12. 12. Bassett ML， Halliday JW， Powell LW. Value of hepatic iron measurements in early hemochromatosis and determination of the critical iron level associated with fibrosis[J]. Hepatology， 1986， 6(1)：24-29.
  13. 13. Deugnier YM， Turlin B， Powell LW， et al. Differentiationbetween heterozygotes and homozygotes in genetic hemochromatosis by means of a histological hepatic iron index：a study of 192 cases[J]. Hepatology， 1993， 17(1)：30-34.
  14. 14. Scheuer PJ， Williams R， Muir AR. Hepatic pathology in relativesof patients with hemochromatosis[J]. J Pathol Bacteriol， 1962， 84：53-64.
  15. 15. Ludwig J， Batts KP， Moyer TP， et al. Liver biopsy diagnosis of homozygous hemochromatosis： a diagnostic algorithm[J]. Mayo Clin Proc， 1993， 68(3)：263-267.
  16. 16. Deugnier YM， Loréal O， Turlin B， et al. Liver pathology in genetic hemochromatosis：a review of 135 homozygous cases and their bioclinical correlations[J]. Gastroenterology， 1992， 102(6)：2050-2059.
  17. 17. Ludwig J， Hashimoto E， Porayko MK， et al. Hemosiderosis in cirrhosis：a study of 447 native livers[J]. Gastroenterology， 1997， 112(3)：882-888.
  18. 18. Guyader D， Gandon Y， Deugnier Y， et al. Evaluation of computedtomography in the assessment of liver iron overload：a study of 46 cases of idiopathic hemochromatosis[J]. Gastroenterology， 1989， 97(3)： 737-743.
  19. 19. Howard JM， Ghent CN， Carey LS， et al. Diagnostic efficacy of hepatic computed tomography in the detection of body iron overload[J]. Gastroenterology， 1983， 84(2)：209-215.
  20. 20. Houang MT， Arozena X， Skalicka A， et al. Correlation between computed tomographic values and liver iron content in thalassaemia major with iron overload[J]. Lancet， 1979， 1(8130)： 1322-1323.
  21. 21. Goldberg HI， Cann CE， Moss AA， et al. Noninvasive quantitation of liver iron in dogs with hemochromatosis using dual-energy CT scanning[J]. Invest Radiol， 1982， 17(4)：375-380.
  22. 22. Fischer MA， Reiner CS， Raptis D， et al. Quantification of liver iron content with CT-added value of dual-energy[J]. Eur Radiol，2011， 21(8)： 1727-1732.
  23. 23. Goldman IS， Winkler ML， Raper SE， et al. Increased hepatic density and phospholipidosis due to amiodarone[J]. AJR Am J Roentgenol， 1985， 144(3)：541-546.
  24. 24. De Maria M， De Simone G， Laconi A， et al. Gold storage in the liver：appearance on CT scans[J]. Radiology， 1986， 159(2)：355-356.
  25. 25. Gomori JM， Horev G， Tamary H， et al. Hepatic iron overload：quantitative MR imaging[J]. Radiology， 1991， 179(2)：367-369.
  26. 26. Farrell DE， Tripp JH， Zanzucchi PE， et al. Magnetic measurement of human iron stores[J]. IEEE Trans Magnetics， 1980， 16(5)： 818-823.
  27. 27. Brittenham GM， Farrell DE， Harris JW， et al. Magnetic-susceptibility measurement of human iron stores[J]. N Engl J Med， 1982， 307(27)： 1671-1675.
  28. 28. Sheth S. SQUID biosusceptometry in the measurement of hepatic iron[J]. Pediatr Radiol， 2003， 33(6)： 373-377.
  29. 29. Nielsen P， Engelhardt R， Düllmann J， et al. Non-invasive liver iron quantification by SQUID-biosusceptometry and serum ferritiniron as new diagnostic parameters in hereditary hemochromatosis[J]. Blood Cells Mol Dis， 2002， 29(3)： 451-458.
  30. 30. Fischer R， Tiemann CD， Engelhardt R， et al. Assessment of iron stores in children with transfusion siderosis by biomagnetic liver susceptometry[J]. Am J Hematol， 1999， 60(4)：289-299.
  31. 31. Fischer R， Piga A， Harmatz P， et al. Monitoring long-termefficacy of iron chelation treatment with biomagnetic liver susceptometry[J]. Ann N Y Acad Sci， 2005， 1054： 350-357.
  32. 32. Idbaih A， Boukobza M， Crassard I， et al. MRI of clot in cerebralvenous thrombosis：high diagnostic value of susceptibility-weighted images[J]. Stroke， 2006， 37(4)：991-995.
  33. 33. Nielsen P， Engelhardt R， Duerken M， et al. Using SQUID biomagnetic liver susceptometry in the treatment of thalassemia and other iron loading diseases[J]. Transfus Sci， 2000， 23(3)：257-258.
  34. 34. Gandon Y， Olivié D， Guyader D， et al. Non-invasive assessment of hepatic iron stores by MRI[J]. Lancet， 2004， 363(9406)：357-362.
  35. 35. Jensen PD. Evaluation of iron overload[J]. Br J Haematol， 2004， 124(6)：697-711.
  36. 36. Jensen PD， Jensen FT， Christensen T， et al. Non-invasiveassessment of tissue iron overload in the liver by magnetic resonanceimaging[J]. Br J Haematol， 1994， 87(1)： 171-184.
  37. 37. Bonkovsky HL， Rubin RB， Cable EE， et al. Hepatic ironconcentration：noninvasive estimation by means of MR imaging techniques[J]. Radiology， 1999， 212(1)： 227-234.
  38. 38. Papakonstantinou OG， Maris TG， Kostaridou V， et al. Assessment of liver iron overload by T2-quantitative magnetic resonance imaging：correlation of T2-QMRI measurements with serumferritin concentration and histologic grading of siderosis[J]. Magn Reson Imaging， 1995， 13(7)： 967-977.
  39. 39. Anderson LJ， Holden S， Davis B， et al. Cardiovascular T2-star (T2*) magnetic resonance for the early diagnosis of myocardial iron overload[J]. Eur Heart J， 2001， 22(23)： 2171-2179.
  40. 40. Ernst O， Sergent G， Bonvarlet P， et al. Hepatic iron overload：diognosis and quantification with MR imaging[J]. AJR Am J Roentgenol， 1997， 168(5)：1205-1208.
  41. 41. Queiroz-Andrade M， Blasbalg R， Ortega CD， et al. MR Imagingfindings of iron overload[J]. Radiographics， 2009， 29(6)：1575-1589.
  42. 42. Tziomalos K， Perifanis V. Liver iron content determination by magnetic resonance imaging[J]. World J Gastroenterol， 2010， 16(13)： 1587-1597.
  43. 43. Westwood M， Anderson LJ， Firmin DN， et al. A single breath-hold multiecho T2* cardiovascular magnetic resonance technique for diagnosis of myocardial iron overload[J]. J Magn Reson Imaging， 2003， 18(1)：33-39.
  44. 44. Hankins JS， McCarville MB， Loeffler RB，et al. R2* magnetic resonance imaging of the liver in patients with iron overload[J]. Blood， 2009， 113(20)：4853-4855.
  45. 45. Wood JC， Enriquez C， Ghugre N， et al. MRI R2 and R2* mappingaccurately estimates hepatic iron concentration in transfusion-dependent thalassemia and sickle cell disease patients[J]. Blood， 2005， 106(4)：1460-1465.
  46. 46. St Pierre TG， Clark PR， Chua-Anusorn W. Single spin-echo protontransverse relaxometry of iron loaded-liver[J]. NMR Biomed，2004， 17(7)： 446-458.
  47. 47. Argyropoulou MI， Astrakas L. MRI evaluation of tissue iron burdenin patients with beta-thalassaemia major[J]. Pediatr Radiol， 2007， 37(12)： 1191-1200.
  48. 48. Haacke EM， Reichenbach JR. Susceptibility weighted imaging in MRI：basic concepts and clinical applications[M]. Hoboken， New Jersey：John Wiley&Sons， 2011：10.
  49. 49. Angelucci E， Giovagnoni A， Valeri G， et al. Limitations of magnetic resonance imaging in measurement of hepatic iron[J]. Blood， 1997， 90(12)： 4736-4742.
  50. 50. Reichenbach JR， Venkatesan R， Schillinger DJ， et al. Small vesselsin the human brain：MR venography with deoxyhemoglobin as an intrinsic contrast agent[J]. Radiology， 1997， 204(1)：272-277.
  51. 51. Haacke EM， Xu Y， Cheng YC， et al. Susceptibility weighted imaging (SWI)[J]. Magn Reson Med， 2004， 52(3)： 612-618.
  52. 52. Dai Y， Zeng M， Li R， et al. Improving detection of siderotic nodules in cirrhotic liver with a multi-breath-hold susceptibility weighted imaging technique[J]. J Magn Reson Imaging， 2011， 34(2)： 318-325.
  53. 53. Tao R， Zhang J， Dai Y， et al. An in vitro and in vivo analysisof the correlation between susceptibility-weighted imaging phase values and R2* in cirrhotic livers[J]. PLoS One， 2012， 7(9)： e45477.
  54. 54. Haacke EM， Miao Y， Liu M， et al. Correlation of putative iron content as represented by changes in R2* and phase with age in deep gray matter of healthy adults[J]. J Magn Reson Imaging， 2010， 32(3)： 561-576.