Nagamachi S, Hoshi H, Ohnishi T, Jinnouchi S, Futami S, Watanabe K, Nakatsuru K, Toshimori T, Matsukura S
Department of Radiology, Miyazaki Medical College.
Kaku Igaku. 1994 Sep;31(9):1059-69.
123I-metaiodobenzylguanidine (MIBG) myocardial scintigraphy was performed in 20 diabetic patients (NIDDM) and 8 control subjects to investigate the association between clinical autonomic nerve dysfunction and myocardial accumulation of MIBG. We used coefficient variance of R-R interval (CVR-R) as a index of the autonomic neuropathy and categorized diabetes into two groups (CVR-R > or = 2.0: non-autonomic neuropathy. CVR-R < 2.0: autonomic neuropathy). In planar imaging studies, heart to mediastinum MIBG uptake ratio (H/M) was calculated on both early and delayed images. The washout ratio of 123I-MIBG in the heart (%WR) was also obtained using myocardial tracer activity on the both images. Mean value of these indices in diabetic group did not reveal any significant difference with the value in the control group. On the SPECT images, low uptake was observed in the posterior-inferior wall with normal uptake of 201Tl in diabetic patients with non-autonomic neuropathy. These areas extended in patients with autonomic neuropathy. The mean value of count ratio of posterior-interior to anterior wall (posterior-inferior/anterior ratio: PI/A) in the diabetic autonomic neuropathy group was significantly higher than in the control group on the both early and delayed images. And the mean value of regional %WR in the posterior-inferior wall calculated by the both MIBG SPECT images was significantly higher in the non-autonomic neuropathy group than in the control group. In the diabetic patients, retention mechanism of 123I-MIBG was considered to be involved at an early stage without autonomic nerve dysfunction clinically. As autonomic neuropathy progressed severely, uptake mechanism was also supposed to be involved. Therefore, 123I-MIBG myocardial scintigraphy was useful for early detection of cardiac sympathetic nervous dysfunction in diabetic patients.
对20例2型糖尿病患者和8名对照者进行了123I-间碘苄胍（MIBG）心肌闪烁显像，以研究临床自主神经功能障碍与MIBG心肌摄取之间的关系。我们将RR间期的变异系数（CVR-R）作为自主神经病变的指标，并将糖尿病患者分为两组（CVR-R≥2.0：无自主神经病变。CVR-R＜2.0：自主神经病变）。在平面显像研究中，在早期和延迟图像上均计算心脏与纵隔的MIBG摄取比值（H/M）。还利用两张图像上的心肌示踪剂活性获得心脏中123I-MIBG的洗脱率（%WR）。糖尿病组这些指标的平均值与对照组的值相比未显示出任何显著差异。在单光子发射计算机断层扫描（SPECT）图像上，无自主神经病变的糖尿病患者下后壁摄取较低，而201铊摄取正常。这些区域在自主神经病变患者中有所扩大。在早期和延迟图像上，糖尿病自主神经病变组后下壁与前壁计数比值（后下/前比值：PI/A）的平均值均显著高于对照组。并且，由两张MIBG SPECT图像计算得出的后下壁区域%WR的平均值在无自主神经病变组中显著高于对照组。在糖尿病患者中，临床上在无自主神经功能障碍的早期阶段即认为123I-MIBG的潴留机制参与其中。随着自主神经病变的严重进展，摄取机制也被认为参与其中。因此，123I-MIBG心肌闪烁显像有助于早期检测糖尿病患者的心脏交感神经功能障碍。
