Uehara A, Kurata C, Sugi T, Mikami T, Shouda S
Department of Medicine III, Hamamatsu University School of Medicine, Japan.
Ann Nucl Med. 1999 Apr;13(2):95-100. doi: 10.1007/BF03164884.
Diabetic cardiac autonomic dysfunction often causes lethal arrhythmia and sudden cardiac death. 123I-Metaiodobenzylguanidine (MIBG) can evaluate cardiac sympathetic dysfunction, and analysis of heart rate variability (HRV) can reflect cardiac parasympathetic activity. We examined whether cardiac parasympathetic dysfunction assessed by HRV may correlate with sympathetic dysfunction assessed by MIBG in diabetic patients.
In 24-hour electrocardiography, we analyzed 4 HRV parameters: high-frequency power (HF), HF in the early morning (EMHF), rMSSD and pNN50. MIBG planar images and SPECT were obtained 15 minutes (early) and 150 minutes (late) after injection and the heart washout rate was calculated. The defect score in 9 left ventricular regions was scored on a 4 point scale (0 = normal approximately 3 = severe defect). In 20 selected diabetic patients without congestive heart failure, coronary artery disease and renal failure, parasympathetic HRV parameters had a negative correlation with the sum of defect scores (DS) in the late images (R = -0.47 approximately -0.59, p < 0.05) and some parameters had a negative correlation with the washout rate (R = -0.50 approximately -0.55, p < 0.05). In a total of 64 diabetic patients also, these parameters had a negative correlation with late DS (R = -0.28 approximately -0.35, p < 0.05) and early DS (R = -0.27 approximately -0.32, p < 0.05).
The progress of diabetic cardiac parasympathetic dysfunction may parallel the sympathetic one.
糖尿病性心脏自主神经功能障碍常导致致命性心律失常和心源性猝死。123I-间碘苄胍（MIBG）可评估心脏交感神经功能障碍，心率变异性（HRV）分析可反映心脏副交感神经活动。我们研究了通过HRV评估的糖尿病患者心脏副交感神经功能障碍是否与通过MIBG评估的交感神经功能障碍相关。
在24小时心电图检查中，我们分析了4个HRV参数：高频功率（HF）、清晨HF（EMHF）、rMSSD和pNN50。注射后15分钟（早期）和150分钟（晚期）获得MIBG平面图像和单光子发射计算机断层扫描（SPECT），并计算心脏洗脱率。对9个左心室区域的缺损评分采用4分制（0 = 正常，约3 = 严重缺损）。在20例选定的无充血性心力衰竭、冠状动脉疾病和肾衰竭的糖尿病患者中，副交感神经HRV参数与晚期图像缺损评分总和（DS）呈负相关（R = -0.47至-0.59，p < 0.05），一些参数与洗脱率呈负相关（R = -0.50至-0.55，p < 0.05）。在总共64例糖尿病患者中，这些参数也与晚期DS呈负相关（R = -0.28至-0.35，p < 0.05）和早期DS呈负相关（R = -0.27至-0.32，p < 0.05）。
糖尿病性心脏副交感神经功能障碍的进展可能与交感神经功能障碍平行。
