Yoo Sang-Won, Kim Joong-Seok, Oh Yoon-Sang, Ryu Dong-Woo, Ha Seunggyun, Yoo Ji-Yeon, Lee Kwang-Soo
Department of Neurology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
Division of Nuclear Medicine, Department of Radiology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
NPJ Parkinsons Dis. 2021 Aug 12;7(1):71. doi: 10.1038/s41531-021-00217-3.
Reduced uptake of I-meta-iodobenzylguanidine (I-MIBG) and orthostatic hypotension (OH) are independently associated with worse clinical outcomes of Parkinson's disease (PD). However, their interactive influence on PD has not been studied. The role of I-MIBG myocardial uptake, as a biomarker of PD severity, was investigated, conditional on the mediating effects of OH. A total of 227 PD patients were enrolled. Their motor and nonmotor aspects were assessed with standardized tools. Global disease burden was estimated by averaging the scaled z-scores of the assessment tools. Every patient went through I-MIBG scan, and OH was evaluated with the head-up tilt-test. The mediating role of orthostatic blood pressure changes (ΔBP) on the association between cardiac sympathetic denervation and disease burden was investigated. Low heart-to-mediastinum (H/M) ratio with less than 1.78 was seen in 69.6% of the patient population, and 22.9% of patients had OH. Low H/M ratio was associated with OH, and these patients had worse disease burden than subjects with normal I-MIBG uptake (global composite z-score: normal I-MIBG vs. abnormal I-MIBG; -0.3 ± 0.5 vs. 0.1 ± 0.7; p < 0.001). The mediation models, controlled for age and disease duration, revealed that the delayed H/M ratio and global composite score were negatively associated, irrespective of orthostatic ΔBP. Adverse relationship between cardiac sympathetic denervation and disease burden was shown without any interference from orthostatic blood pressure fluctuations. This result suggested that extracranial cardiac markers might reflect disease burden, regardless of labile blood pressure influence.
1-间碘苄胍（I-MIBG）摄取减少和体位性低血压（OH）与帕金森病（PD）较差的临床结局独立相关。然而，它们对PD的交互影响尚未得到研究。在OH的中介作用条件下，研究了I-MIBG心肌摄取作为PD严重程度生物标志物的作用。共纳入227例PD患者。使用标准化工具评估他们的运动和非运动方面。通过对评估工具的标准化z评分求平均值来估计整体疾病负担。每位患者均接受I-MIBG扫描，并通过头高位倾斜试验评估OH。研究了体位性血压变化（ΔBP）对心脏交感神经去神经支配与疾病负担之间关联的中介作用。69.6%的患者人群出现心脏与纵隔（H/M）比值低于1.78，22.9%的患者有OH。低H/M比值与OH相关，这些患者的疾病负担比I-MIBG摄取正常的受试者更差（整体综合z评分：I-MIBG正常 vs. I-MIBG异常；-0.3±0.5 vs. 0.1±0.7；p<0.001）。在控制年龄和病程的中介模型中，无论体位性ΔBP如何，延迟的H/M比值与整体综合评分均呈负相关。显示心脏交感神经去神经支配与疾病负担之间存在不良关系，不受体位性血压波动的任何干扰。该结果表明，无论血压不稳定的影响如何，颅外心脏标志物可能反映疾病负担。
