刘虎 赵宏伟

摘要：在血液透析患者中，长期贫血治疗使用的频繁输血和静脉注射铁剂方法会增加肝脏铁过载和肝脂肪变性的风险，铁的病理性累积也会对肝细胞造成损伤，不仅增加了患者发展为进行性肝纤维化和肝硬化的风险，还可能加快肝脂肪变性的进程。铁过载和脂肪变性的这种双重影响可能相互作用，加剧肝损伤，导致患者肝纤维化和肝硬化病情进一步恶化。现代MRI技术具有无创性和高重复性的特点，能够同时定量评估肝脏铁和脂肪含量，为早期诊断和干预肝脏疾病提供重要依据。近年来，现代MRI技术在肝脏疾病诊疗领域的应用取得了显著进展，可以准确反映患者肝脏铁过载和肝脂肪变性程度，并预测肝脏疾病发生风险。本文综述了使用现代MRI技术评估血液透析患者肝脏铁过载和肝脂肪变性状况的最新进展和面临的挑战以及未来展望，旨在为临床实践提供有价值的参考。

关键词：血液透析；肝脏铁过载；肝脂肪变性；MRI；定量评估

中图分类号： R445.2  文献标识码： A  文章编号：1000-503X（2024）03-0449-09

DOI：10.3881/j.issn.1000-503X.16066

MRI-Based Assessment of Hepatic Iron Overload and Steatosis in Patients Undergoing Hemodialysis：Current Status，Challenges，and Perspectives

LIU Hu，ZHAO Hongwei

Department of Radiology，The Second Hospital of Jiaxing，Jiaxing，Zhejiang 314000，China

Corresponding author：ZHAO Hongwei Tel：0573-82090467，E-mail：zhw0314@hotmail.com

ABSTRACT：Long-term treatment of anemia involving frequent blood transfusions and intravenous iron administration increases the risks of hepatic iron overload and steatosis in the patients undergoing hemodialysis.Pathological accumulation of iron damages hepatocytes，not only elevating the risks of progressive hepatic fibrosis and cirrhosis but also potentially accelerating the process of hepatic steatosis.Iron overload and steatosis may interact with each other，exacerbating liver damage and ultimately leading to further deterioration of hepatic fibrosis and cirrhosis.MRI characterized by non-invasiveness and high repeatability，enables the simultaneous quantitative assessment of hepatic iron and fat content，providing crucial information for early diagnosis and intervention of liver diseases.In recent years，researchers have achieved significant advances in the application of MRI in the diagnosis and treatment of liver diseases.MRI can accurately reflect the extent of hepatic iron overload and steatosis in patients and predict the risk of liver diseases.This article reviews the latest advances，challenges，and perspectives in the application of MRI in assessing hepatic iron overload and steatosis in the patients undergoing hemodialysis，aiming to offer valuable references for clinical practice.

Key words：hemodialysis；hepatic iron overload；hepatic steatosis；MRI；quantitative assessment

Acta Acad Med Sin，2024，46（3）：449-457

随着全球慢性肾脏疾病（chronic kidney disease，CKD）患病率的持续上升，全球约有9.1%的人口，近7亿人受到CKD的影响［1］。在中国，CKD患病率高达10.8%，约有1.2亿人受到影响，且许多患者最终还需要血液透析，截至2021年底，国内约有75.1万患者正在进行血液透析治疗［2-3］。

中国的临床试验数据显示接受透析患者中贫血具有普遍性，透析患者中贫血的发病率为91.6%～98.2%［4］。血液透析患者还常常伴有营养不良、代谢紊乱等因素，这些因素也会增加肝脂肪变性的风险，从而影响精确测量肝脏铁含量（liver iron content，LIC）的过程［5］。……