长期胰岛素依赖型（I型）糖尿病患者心脏交感神经去神经支配闪烁显像评估的三年随访

Three-year follow-up on scintigraphically assessed cardiac sympathetic denervation in patients with long-term insulin-dependent (type I) diabetes mellitus.

作者信息

Schnell O, Muhr D, Weiss M, Kirsch C M, Haslbeck M, Tatsch K, Standl E

机构信息

Diabetes Research Institute, Schwabing City Hospital, Munich, Germany.

出版信息

J Diabetes Complications. 1997 Sep-Oct;11(5):307-13. doi: 10.1016/s1056-8727(97)00015-9.

DOI:10.1016/s1056-8727(97)00015-9

PMID:9334913

Abstract

Scintigraphy using I-123-metaiodobenzylguanidine (I-123-MIBG) and Tc-99m-methoxyisobutylisonitrile (Tc-99m-MIBI) allows assessment of the cardiac sympathetic innervation and the myocardial perfusion. To investigate the natural history of cardiac sympathetic denervation in long-term diabetic patients without myocardial perfusion defects, global and regional I-123-MIBG and Tc-99m-MIBI uptake was determined (score 1-6; 1 = normal uptake, 6 = no uptake) in 22 patients with insulin-dependent (type I) diabetes mellitus (IDDM) at 3-year follow-up. All patients were treated with intensive insulin therapy and HbA1c was 8.0% +/- 1.0% at entry compared with 7.9% +/- 1.1% at follow-up. Cardiac sympathetic denervation (I-123-MIBG uptake score > 2), initially observed in 18 patients, was detectable in 21 patients at follow-up. The global myocardial I-123-MIBG uptake score deteriorated in eight patients, remained unchanged in 11 and improved in three patients. The changes in mean global I-123-MIBG uptake score (3.5 +/- 1.0 versus 3.8 +/- 0.8) were not significant. Reduction of the anterior, lateral, posterior, septal, and apical I-123-MIBG uptake did not progress significantly during follow-up. The mean uptake score of the posterior myocardial region (4.7 +/- 0.8) was smaller than the uptake score of the anterior (3.0 +/- 1.1, p = 0.001), lateral (3.2 +/- 0.9, p < 0.001) and septal (4.1 +/- 1.1, p < 0.05) myocardial regions. At follow-up, moderate myocardial perfusion defects (global Tc-99m-MIBI uptake score = 3) were detectable in four patients. Our study demonstrates that scintigraphically assessed cardiac sympathetic denervation does neither significantly regress nor progress on the average in a group of long-term IDDM patients during a 3-year follow-up. Thus, it is concluded that cardiac sympathetic abnormalities are a persistent, yet frequent phenomenon in long-term IDDM patients.

摘要

使用I-123-间碘苄胍（I-123-MIBG）和锝-99m-甲氧基异丁基异腈（Tc-99m-MIBI）的闪烁显像可用于评估心脏交感神经支配和心肌灌注情况。为了研究无心肌灌注缺损的长期糖尿病患者心脏交感神经去神经支配的自然病程，在22例胰岛素依赖型（I型）糖尿病（IDDM）患者随访3年时，测定了其整体和局部的I-123-MIBG及Tc-99m-MIBI摄取情况（评分1 - 6；1 = 正常摄取，6 = 无摄取）。所有患者均接受强化胰岛素治疗，入组时糖化血红蛋白（HbA1c）为8.0%±1.0%，随访时为7.9%±1.1%。心脏交感神经去神经支配（I-123-MIBG摄取评分>2）最初在18例患者中观察到，随访时在21例患者中可检测到。整体心肌I-123-MIBG摄取评分在8例患者中恶化，11例患者保持不变，3例患者改善。整体I-123-MIBG摄取评分的变化（3.5±1.0对3.8±0.8）无显著意义。随访期间，前壁、侧壁、后壁、间隔和心尖部I-123-MIBG摄取的降低未显著进展。心肌后壁区域的平均摄取评分（4.7±0.8）低于前壁（3.0±1.1，p = 0.001）、侧壁（3.2±0.9，p < 0.001）和间隔（4.1±1.1，p < 0.05）心肌区域。随访时，4例患者可检测到中度心肌灌注缺损（整体Tc-99m-MIBI摄取评分 = 3）。我们的研究表明，在一组长期IDDM患者3年随访期间，闪烁显像评估的心脏交感神经去神经支配平均既无显著消退也无进展。因此，得出结论，心脏交感神经异常在长期IDDM患者中是一种持续但常见的现象。