Gürtner C, Schacherer C, Krause B J, Zickmann J, Klepzig H, Hör G
Abteilung Nuklearmedizin, Universitätsklinikum Frankfurt am Main, Deutschland.
Nuklearmedizin. 1996 Aug;35(4):105-11.
Examination of the integrity of the sympathetic nervous system in patients with angiographically proven coronary artery disease and ECG documented asymptomatic ST-segment depression.
Stress and rest myocardial perfusion scintigraphy using either Thallium-201 or 99mTc-isonitrile was performed in SPECT technique in order to localize ischemia or scar associated perfusion defects. 15 min and 4 h p.i. static anterior 123I-MIBG uptake was acquired. In order to localize norepinephrine depletion 4 h p.i. additional 123I-MIBG SPECT acquisition was performed. Incidence of arrhythmias was investigated by Holter ECG. Patients with diabetes mellitus were excluded.
SPECT images showed in all patients regional 123I-MIBG depletion which corresponded with scintigraphically infarcted or ischemic regions. Well perfused myocardial regions matched with regular 123I-MIBG uptake. There was no evidence of increased arrhythmias in long-term ECG.
The finding of regular 123I-MIBG uptake in well-perfused myocardium and infarction- or ischemia-associated regional 123I-MIBG depletion confirms that silent ischemia is not caused by a global sympathetic nervous dysfunction in a sense of cardiac polyneuropathy.
检查经血管造影证实患有冠状动脉疾病且心电图记录有无症状ST段压低的患者交感神经系统的完整性。
采用单光子发射计算机断层扫描（SPECT）技术，使用铊-201或锝-99m异腈进行静息和负荷心肌灌注闪烁显像，以定位与缺血或瘢痕相关的灌注缺损。注射后15分钟和4小时采集静态前位123I-间碘苄胍（123I-MIBG）摄取图像。为了定位去甲肾上腺素耗竭情况，注射后4小时额外进行一次123I-MIBG SPECT采集。通过动态心电图监测调查心律失常的发生率。排除糖尿病患者。
SPECT图像显示，所有患者均存在局部123I-MIBG耗竭，这与闪烁显像显示的梗死或缺血区域相对应。心肌灌注良好的区域与正常的123I-MIBG摄取相匹配。长期心电图检查未发现心律失常增加的证据。
在心肌灌注良好区域123I-MIBG摄取正常，而在梗死或缺血相关区域出现局部123I-MIBG耗竭，这一发现证实，从心脏多发性神经病变的角度来看，无症状性缺血并非由整体交感神经功能障碍所致。
