Department of Nuclear Medicine and PET Centre, Aarhus University Hospital, Palle Juul-Jensens Boulevard 165, 8200 Aarhus N, Denmark; Institute of Clinical Medicine, Aarhus University, Denmark.
Department of Nuclear Medicine and PET Centre, Aarhus University Hospital, Palle Juul-Jensens Boulevard 165, 8200 Aarhus N, Denmark.
Parkinsonism Relat Disord. 2022 Aug;101:99-104. doi: 10.1016/j.parkreldis.2022.07.005. Epub 2022 Jul 16.
Most patients with isolated rapid eye movement sleep behaviour disorder (iRBD) convert to Parkinson's disease (PD), dementia with Lewy bodies, or multiple system atrophy within 15 years of diagnosis. Furthermore, iRBD patients develop non-motor symptoms similar to those of manifest PD patients and display dysfunction of the sympathetic and parasympathetic nervous system, comparable to that seen in PD. However, progression rates of autonomic dysfunction in iRBD have not been studied with objective measures in detail, which is the aim of this study.
Twenty-two iRBD patients were included at baseline and 14 participated in follow-up after 3 years. Colonic transit time (CTT) was examined using radio opaque markers, colonic volume was defined on abdominal computed tomography (CT) scans, Iodine-123-metaiodobenzylguanidine ([123I]MIBG) scintigraphy was performed to assess cardiac sympathetic innervation, and 3,4-dihydroxy-6-(18F) fluoro-l-phenylalanine ([18F]FDOPA) positron emission tomography (PET) scan determined nigrostriatal dopamine storage capacity. All examinations were performed at baseline and after 3 years.
iRBD patients displayed increased CTT (p = 0.001) and colonic volume (p = 0.01) at follow-up compared to baseline. Furthermore, [123I]MIBG uptake and [18F]FDOPA uptake showed progressive reductions at follow-up (p = 0.02 and p = 0.002, respectively). No correlations were seen between changes in intestinal or cardiac measurements and dopaminergic function.
Using objective markers, the present study documented that intestinal dysfunction and cardiac sympathetic degeneration worsen in the majority of iRBD patients over a 3-year period. The absent correlation between these markers and nigrostriatal dopaminergic dysfunction suggests that progressive gastrointestinal and cardiac dysfunction in iRBD is caused mainly by non-dopaminergic mechanisms.
大多数孤立性快速眼动睡眠行为障碍（iRBD）患者在诊断后 15 年内会转化为帕金森病（PD）、路易体痴呆或多系统萎缩。此外，iRBD 患者会出现类似于显性 PD 患者的非运动症状，并表现出交感和副交感神经系统功能障碍，与 PD 相似。然而，iRBD 自主神经功能障碍的进展速度尚未通过客观测量进行详细研究，这是本研究的目的。
22 例 iRBD 患者在基线时纳入研究，14 例患者在 3 年后进行了随访。使用放射性不透射线标志物检查结肠通过时间（CTT），通过腹部计算机断层扫描（CT）定义结肠容量，进行碘-123-间位碘苄胍（[123I]MIBG）闪烁扫描以评估心脏交感神经支配，并用 3,4-二羟基-6-（18F）氟-L-苯丙氨酸（[18F]FDOPA）正电子发射断层扫描（PET）扫描确定黑质纹状体多巴胺储存能力。所有检查均在基线和 3 年后进行。
与基线相比，iRBD 患者在随访时显示 CTT 增加（p=0.001）和结肠容量增加（p=0.01）。此外，[123I]MIBG 摄取和[18F]FDOPA 摄取在随访时显示出进行性减少（p=0.02 和 p=0.002）。肠道或心脏测量的变化与多巴胺能功能之间无相关性。
本研究使用客观标志物证明，在 3 年期间，大多数 iRBD 患者的肠道功能障碍和心脏交感神经退行性变恶化。这些标志物与黑质纹状体多巴胺能功能障碍之间不存在相关性表明，iRBD 中进行性的胃肠道和心脏功能障碍主要由非多巴胺能机制引起。
