Oka Hisayoshi, Yoshioka Masayuki, Morita Masayo, Mochio Soichiro, Inoue Kiyoharu
Aoto Hospital, Department of Neurology, Jikei University School of Medicine.
Rinsho Shinkeigaku. 2003 Aug;43(8):465-9.
We examined whether the results of 123I-MIBG scintigraphy reflect cardiac sympathetic nerve function in patients with Parkinson's disease (PD). The subjects were 62 patients with Parkinson's disease (age, 65.4 +/- 6.3 years) and 53 controls (65.2 +/- 7.1 years). All subjects underwent 123I-MIBG scintigraphy and QTc interval measurement on ECG. Hemodynamic autonomic function was estimated by the Valsalva maneuver in 37 subjects (63.9 +/- 5.2 years) randomly selected from the patients with PD. As control, the Valsalva maneuver was also done in 20 randomly selected controls (64.1 +/- 5.0 years), and 123I-MIBG scintigraphy was performed in 21 controls (67.7 +/- 5.3 years old). The subjects rested in a supine position for 20 min and were given an intravenous injection of 111 MBq 123I-MIBG. Relative organ uptake was determined by the region of interest (ROI) in the anterior view and the ratio of average pixel count in the heart (H) to that in the mediastinum (M) was calculated (H/M ratio) for early (after 15 min) and delayed (after 3 hrs) periods. The Valsalva maneuver was done by having the subjects exhale into a mouthpiece at an expiratory pressure of 40 mmHg for 15 seconds. Blood pressure and RR intervals were measured during the Valsalva maneuver by tonometry, using a noninvasive blood pressure monitoring system (ANS 508, Nihon Colin Co., Ltd.). Baroreceptor reflex sensitivities (BRS) of the second phase (BRS II) and fourth phase (BRS IV) of the Valsalva maneuver were calculated, and blood pressure elevations during the late second phase (IIp) and fourth phase (IVp) were measured. QTc was greater in the patients with PD (417 ms) than in the control subjects (409 ms). The H/M ratios of the early and delayed images in the patients with PD (1.76, 1.61) were significantly lower than those in the control subjects (2.56, 2.45). The early and delayed H/M ratios significantly correlated with the severity of disease according to Hoehn-Yahr stage. QTc interval and IVp significantly correlated with early and delayed H/M ratios. No other significant correlations were detected. The early H/M ratio in the patients with PD who had IVp within the normal range was lower than the early H/M ratio in control subjects. Our results show that early and delayed H/M ratio correlates with cardiac autonomic function, evaluated on the basis of QTc interval and the Valsalva maneuver, but not with baroreceptor reflex sensitivity or vasomotor autonomic function. Our findings suggest that silent cardiac autonomic dysfunction may be evaluated by 123I-MIBG scintigraphy, because early and delayed H/M ratios were lower in the patients with PD who had normal IVp than in the control subjects.
我们研究了123I - MIBG闪烁扫描术的结果是否能反映帕金森病（PD）患者的心脏交感神经功能。研究对象为62例帕金森病患者（年龄65.4±6.3岁）和53名对照者（65.2±7.1岁）。所有研究对象均接受了123I - MIBG闪烁扫描术及心电图QTc间期测量。通过瓦尔萨尔瓦动作对随机选取的37例帕金森病患者（63.9±5.2岁）评估血流动力学自主神经功能。作为对照，对随机选取的20名对照者（64.1±5.0岁）进行了瓦尔萨尔瓦动作，并对21名对照者（67.7±5.3岁）进行了123I - MIBG闪烁扫描术。研究对象仰卧休息20分钟后，静脉注射111 MBq的123I - MIBG。在前位图像上通过感兴趣区（ROI）确定相对器官摄取，并计算早期（15分钟后）和延迟期（3小时后）心脏平均像素计数与纵隔平均像素计数的比值（H/M比值）。瓦尔萨尔瓦动作通过让研究对象对着咬嘴呼气，呼气压力为40 mmHg，持续15秒来完成。在瓦尔萨尔瓦动作过程中，使用无创血压监测系统（ANS 508，日本光电株式会社）通过眼压测量法测量血压和RR间期。计算瓦尔萨尔瓦动作第二阶段（BRS II）和第四阶段（BRS IV）的压力感受器反射敏感性（BRS），并测量第二阶段晚期（IIp）和第四阶段（IVp）的血压升高情况。帕金森病患者的QTc（417毫秒）高于对照者（409毫秒）。帕金森病患者早期和延迟图像的H/M比值（1.76，1.61）显著低于对照者（2.56，2.45）。早期和延迟的H/M比值与根据Hoehn - Yahr分期的疾病严重程度显著相关。QTc间期和IVp与早期和延迟的H/M比值显著相关。未检测到其他显著相关性。IVp在正常范围内的帕金森病患者的早期H/M比值低于对照者的早期H/M比值。我们的结果表明，早期和延迟的H/M比值与基于QTc间期和瓦尔萨尔瓦动作评估的心脏自主神经功能相关，但与压力感受器反射敏感性或血管运动自主神经功能无关。我们的研究结果表明，123I - MIBG闪烁扫描术可能有助于评估无症状性心脏自主神经功能障碍，因为IVp正常的帕金森病患者的早期和延迟H/M比值低于对照者。
