Takano H, Ozawa H, Kobayashi I, Hamaoka S, Nakajima J, Nakamura T, Sato K, Kimura H, Naito A, Obata S, Koizumi K, Tamura K
The Second Department of Internal Medicine, Yamanashi Medical College.
J Cardiol. 1996 Feb;27(2):49-55.
Single photon emission computed tomography (SPECT) using I-123 metaiodobenzylguanidine (MIBG) was evaluated for the detection of doxorubicin (DXR) cardiomyopathy in seven patients with malignant lymphoma receiving DXR doses ranging from 70 to 530 mg (DXR group), and 20 normal subjects without hypertension, diabetes mellitus or electrocardiographic abnormalities (control group). The ratio of the heart to mediastinal counts (H/M) and the washout rate (WR) in MIBG SPECT images were compared between the two groups. Correlation of total doses of DXR with H/M and the relationship of H/M to WR were investigated. The H/M of the DXR group was lower than that of the control group (3.00 +/- 0.97 vs 4.90 +/- 1.08, p < 0.001). The WR of the DXR group was higher than that of the control group (30.9 +/- 10.5% vs 16.5 +/- 9.1%, p < 0.001). Total DXR doses were inversely correlated with H/M (r = -0.86), H/M correlated inversely with the WR (r = -0.83) only in the DXR group. Pathological findings of one patient, who died of DXR cardiomyopathy, showed atrophic and fibrotic nerve fibers in the apical inferior segment of the left ventricle where MIBG uptake was reduced markedly. DXR cardiomyopathy can be detected with MIBG SPECT as cardiac sympathetic nervous dysinnervation. The pathological findings correspond to the MIBG SPECT findings.
采用 I-123 间碘苄胍（MIBG）的单光子发射计算机断层扫描（SPECT）用于检测 7 例接受多柔比星（DXR）剂量范围为 70 至 530mg 的恶性淋巴瘤患者（DXR 组）以及 20 例无高血压、糖尿病或心电图异常的正常受试者（对照组）中的 DXR 心肌病。比较了两组 MIBG SPECT 图像中心脏与纵隔计数比（H/M）和洗脱率（WR）。研究了 DXR 总剂量与 H/M 的相关性以及 H/M 与 WR 的关系。DXR 组的 H/M 低于对照组（3.00±0.97 对 4.90±1.08，p<0.001）。DXR 组的 WR 高于对照组（30.9±10.5%对 16.5±9.1%，p<0.001）。DXR 总剂量与 H/M 呈负相关（r = -0.86），仅在 DXR 组中 H/M 与 WR 呈负相关（r = -0.83）。1 例死于 DXR 心肌病的患者的病理结果显示，左心室心尖下壁萎缩和纤维化的神经纤维，此处 MIBG 摄取明显减少。MIBG SPECT 可检测到 DXR 心肌病导致的心脏交感神经去神经支配。病理结果与 MIBG SPECT 结果相符。
