Schnell O, Muhr D, Weiss M, Dresel S, Haslbeck M, Standl E
Diabetes Research Institute, Schwabing City Hospital, Munich, Germany.
Diabetes. 1996 Jun;45(6):801-5. doi: 10.2337/diab.45.6.801.
123I-labeled metaiodobenzylguanidine (123I-MIBG) scintigraphy is a novel technique for the assessment of cardiac sympathetic dysinnervation. To evaluate defects of the cardiac autonomic nervous system at the onset of IDDM, this technique together with conventional electrocardiogram (ECG)-based cardiac reflex tests and measurement of the QT interval was applied to 22 newly diagnosed metabolically stabilized IDDM patients without myocardial perfusion abnormalities (99mTc-labeled methoxyisobutylisonitrile scintigraphy) and 9 matched control subjects. Seventeen diabetic patients (77%), but none of the control subjects, were observed to have a reduced global myocardial uptake of 123I-MIBG. In contrast, only two diabetic patients (9%) demonstrated an ECG-based cardiac autonomic neuropathy (two or more of five age-related cardiac reflex tests abnormal) (P < 0.001). In newly diagnosed IDDM patients, the uptake of 123I-MIBG was reduced more in the posterior myocardial region compared with the lateral and apical region (P < 0.01, P = 0.03). The septal myocardial region exhibited a smaller uptake than the lateral myocardial region (P = 0.02). The maximum/minimum 30:15 ratio correlated with the global, anterior, lateral, and septal myocardial uptake of 123I-MIBG (P < 0.05, P < 0.05, P < 0.01, P < 0.05). A correlation between global and regional myocardial 123I-MIBG uptake and HbA1c or QT interval was not observed. Newly diagnosed metabolically stabilized IDDM patients without myocardial perfusion defects show evidence of cardiac sympathetic dysinnervation, as indicated by a reduction of 123I-MIBG uptake, at a significant higher proportion than ECG-based cardiac autonomic neuropathy. Furthermore, they present with regional differences of myocardial 123I-MIBG uptake.
123I标记的间碘苄胍（123I-MIBG）闪烁扫描术是一种用于评估心脏交感神经去神经支配的新技术。为了评估1型糖尿病发病时心脏自主神经系统的缺陷，该技术与基于常规心电图（ECG）的心脏反射试验以及QT间期测量一起应用于22例新诊断的代谢稳定的1型糖尿病患者，这些患者无心肌灌注异常（99mTc标记的甲氧基异丁基异腈闪烁扫描术）以及9名匹配的对照受试者。观察到17例糖尿病患者（77%）存在123I-MIBG的整体心肌摄取减少，但对照受试者中无一例出现这种情况。相比之下，只有2例糖尿病患者（9%）表现出基于ECG的心脏自主神经病变（五项与年龄相关的心脏反射试验中有两项或更多异常）（P<0.001）。在新诊断的1型糖尿病患者中，与外侧和心尖区域相比，后心肌区域的123I-MIBG摄取减少更为明显（P<0.01，P = 0.03）。间隔心肌区域的摄取小于外侧心肌区域（P = 0.02）。最大/最小30:15比值与123I-MIBG的整体、前壁、侧壁和间隔心肌摄取相关（P<0.05，P<0.05，P<0.01，P<0.05）。未观察到整体和区域心肌123I-MIBG摄取与糖化血红蛋白（HbA1c）或QT间期之间存在相关性。新诊断的代谢稳定且无心肌灌注缺陷的1型糖尿病患者显示出心脏交感神经去神经支配的证据，表现为123I-MIBG摄取减少，其比例显著高于基于ECG的心脏自主神经病变。此外，他们还存在心肌123I-MIBG摄取的区域差异。
