Kreiner G, Wolzt M, Fasching P, Leitha T, Edlmayer A, Korn A, Waldhäusl W, Dudczak R
Department of Medicine II, University of Vienna, Austria.
Diabetes. 1995 May;44(5):543-9. doi: 10.2337/diab.44.5.543.
Cardiac imaging using m-[123I]iodobenzylguanidine (mIBG) reflects sympathetic myocardial innervation. In patients with insulin-dependent diabetes mellitus (IDDM), the following were studied: 1) the prevalence of derangements of cardiac autonomic innervation as detected by mIBG scintigraphy in comparison with cardiovascular reflex tests and 2) the relationship between adrenergic cardiac innervation and left ventricular (LV) function. Twenty-four patients with IDDM without overt heart disease were studied after silent coronary artery disease was excluded by 201Tl scintigraphy. Cardiac innervation was evaluated by both mIBG scintigraphy (tomographic imaging) and cardiovascular reflex tests. Systolic (ejection fraction [EF] percentage) and diastolic (peak filling rate [PFR] defined as end-diastolic volumes per second [EDV/s]) LV function were determined by equilibrium radionuclide angiography at rest and during bicycle exercise. mIBG scintigraphy was also performed in 10 control subjects. All control subjects exhibited a normal myocardial mIBG distribution. Among diabetic patients, only six had normal mIBG scans (group 1), whereas 18 had evidence of regional adrenergic denervation (group 2). Reflex tests suggested cardiac autonomic neuropathy in only seven of these patients (P < 0.01 vs. mIBG). All patients had a normal EF at rest. However, group 2 showed an impaired response to exercise as indicated by a smaller increase in EF (5 +/- 6 vs. 13 +/- 5%, P < 0.05) and a lower PFR (5.9 +/- 0.8 vs. 7.3 +/- 1.2 EDV/s, P < 0.01). Myocardial mIBG scintigraphy reveals that in patients with IDDM, sympathetic myocardial dysinnervation is much more common than previously thought. Furthermore, subclinical LV dysfunction is related to derangements of adrenergic cardiac innervation.
使用间位[¹²³I]碘苄胍（mIBG）进行心脏成像可反映心肌交感神经支配情况。在胰岛素依赖型糖尿病（IDDM）患者中，进行了以下研究：1）与心血管反射试验相比，通过mIBG闪烁扫描检测到的心脏自主神经支配紊乱的患病率；2）肾上腺素能心脏神经支配与左心室（LV）功能之间的关系。在通过²⁰¹Tl闪烁扫描排除隐匿性冠状动脉疾病后，对24例无明显心脏病的IDDM患者进行了研究。通过mIBG闪烁扫描（断层成像）和心血管反射试验评估心脏神经支配情况。通过静息和自行车运动时的平衡放射性核素血管造影测定左心室收缩功能（射血分数[EF]百分比）和舒张功能（峰值充盈率[PFR]，定义为每秒舒张末期容积[EDV/s]）。还对10名对照受试者进行了mIBG闪烁扫描。所有对照受试者的心肌mIBG分布均正常。在糖尿病患者中，只有6例mIBG扫描正常（第1组），而18例有局部肾上腺素能去神经支配的证据（第2组）。反射试验仅提示其中7例患者存在心脏自主神经病变（与mIBG相比，P<0.01）。所有患者静息时EF均正常。然而，第2组显示运动反应受损，表现为EF增加较小（5±6 vs. 13±5%，P<0.05）和PFR较低（5.9±0.8 vs. 7.3±1.2 EDV/s，P<0.01）。心肌mIBG闪烁扫描显示，在IDDM患者中，交感神经心肌去神经支配比以前认为的更为常见。此外，亚临床左心室功能障碍与肾上腺素能心脏神经支配紊乱有关。
