（123）帕金森病中的碘代间位苄胍心肌闪烁显像
(123)I-metaiodobenzylguanidine myocardial scintigraphy in Parkinson's disease.
作者信息
Orimo S, Ozawa E, Nakade S, Sugimoto T, Mizusawa H
机构信息
Department of Neurology, 6- 25-1 Kami-Yoga, Setagaya-ku, Tokyo 158, Japan.
出版信息
J Neurol Neurosurg Psychiatry. 1999 Aug;67(2):189-94. doi: 10.1136/jnnp.67.2.189.
OBJECTIVES
(123)I-metaiodobenzylguanidine (MIBG) myocardial scintigraphy is clinically used to estimate local myocardial sympathetic nerve damage in some forms of heart disease, autonomic nerve disturbance in diabetic neuropathy, and disturbance of the autonomic nervous system in neurodegenerative disease. In the present study, examinations were performed to clarify (1) the proportion of cardiac sympathetic nerve disturbance in Parkinson's disease, (2) the usefulness of (123)I-MIBG myocardial scintigraphy to detect sympathetic nerve disturbances compared with autonomic function tests, (3) cardiac function in patients who have a decreased MIBG uptake in (123)I-MIBG myocardial scintigraphy, (4) the usefulness of (123)I-MIBG myocardial scintigraphy to differentiate Parkinson's disease from the other neurological diseases mimicking it.
METHODS
(123)I-MIBG myocardial scintigraphy was performed, together with autonomic function tests and cardiac examinations in 46 patients with Parkinson's disease and 25 patients with vascular parkinsonism, essential tremor, or multiple system atrophy.
RESULTS
In an anterior image study, the average count per pixel in heart to mediastinum (H/M) ratio decreased in 80% of the patients with Parkinson's disease in the early phase and 84% in the late phase. The mean H/M ratio in Parkinson's disease was significantly lower than that in controls and the other diseases. The H/M ratio tended to decrease with the disease progression. In almost half of the patients in Hoehn and Yahr stage I, the H/M ratio was already decreased. The sympathetic skin response in upper and lower limbs, head up tilt test, and coefficient of variation of R-R interval were abnormal in 17%, 31%, 30%, and 17% of the patients, respectively. All the patients with abnormal autonomic functions were in Hoehn and Yahr stage III, IV, or V. Echocardiography showed normal left ventricular function. Twenty four hour Holter electrocardiography detected no serious arrhythmias except for one patient with non-sustained ventricular tachycardia.
CONCLUSION
(123)I-MIBG myocardial scintigraphy might detect early disturbances of the sympathetic nervous system in Parkinson's disease and might give useful diagnostic information to differentiate vascular parkinsonism, essential tremor, and multiple system atrophy from Parkinson's disease.
目的
（123）I - 间碘苄胍（MIBG）心肌闪烁显像在临床上用于评估某些形式心脏病中的局部心肌交感神经损伤、糖尿病神经病变中的自主神经紊乱以及神经退行性疾病中的自主神经系统紊乱。在本研究中，进行相关检查以阐明：（1）帕金森病中心脏交感神经紊乱的比例；（2）与自主神经功能测试相比，（123）I - MIBG心肌闪烁显像检测交感神经紊乱的有效性；（3）（123）I - MIBG心肌闪烁显像中MIBG摄取降低的患者的心脏功能；（4）（123）I - MIBG心肌闪烁显像在鉴别帕金森病与其他类似帕金森病的神经疾病方面的有效性。
方法
对46例帕金森病患者以及25例患有血管性帕金森综合征、特发性震颤或多系统萎缩的患者进行了（123）I - MIBG心肌闪烁显像检查，并同时进行了自主神经功能测试和心脏检查。
结果
在前位图像研究中，帕金森病患者早期80%、晚期84%的心/纵隔（H/M）比值的每像素平均计数降低。帕金森病患者的平均H/M比值显著低于对照组及其他疾病患者。H/M比值倾向于随疾病进展而降低。在几乎一半的Hoehn - Yahr I期患者中，H/M比值已经降低。上肢和下肢的交感皮肤反应、头高位倾斜试验以及R - R间期变异系数分别在17%、31%、30%和17%的患者中异常。所有自主神经功能异常的患者均处于Hoehn - Yahr III期、IV期或V期。超声心动图显示左心室功能正常。24小时动态心电图检查除1例非持续性室性心动过速患者外，未检测到严重心律失常。
结论
（123）I - MIBG心肌闪烁显像可能检测到帕金森病中交感神经系统的早期紊乱，并可能为鉴别血管性帕金森综合征、特发性震颤和多系统萎缩与帕金森病提供有用的诊断信息。
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