帕金森病、多系统萎缩和特发性震颤患者^(131)碘-间碘苄胍心肌显像研究

^(131)I-MIBG myocardial scintigraphy in patients with Parkinson's disease,multiple system atrophy and essential tremor

目的采用131碘-间碘苄胍(^(131)I-MIBG)心肌显像方法评估帕金森病(PD)、多系统萎缩(MSA)及特发性震颤(ET)患者的心脏交感神经功能,以期为上述疾病的鉴别探索新的方法。方法收集PD患者25例,MSA患者18例,ET患者11例和正常对照者10例,所有受试者均行^(131)I-MIBG心肌显像,分别测定计算15 min和4 h两个时间点的心脏/纵膈(H/M)放射性计数比值,作为^(131)I-MIBG心肌摄取率。结果 PD组15 min和4 h两个时间点的H/M值分别为1.65±0.36和1.50±0.43,MSA组分别为1.97±0.36和2.08±0.57,ET组分别为2.34±0.34和2.46±0.51,对照组分别为2.41±0.26和2.66±0.47。两两比较,PD组两个时间点的H/M值均低于MSA组、ET组和对照组相应值(均P<0.05),MSA组两个时间点的H/M值均低于对照组相应值(均P<0.05),ET组与对照组两个时间点的H/M值差异均无统计学意义(均P>0.05)。结论 PD、MSA患者均可发生心脏交感神经功能损害,且PD患者损害更著,而ET患者心脏交感神经功能无明显改变。^(131)I-MIBG心肌显像可能有助于PD、MSA及ET的鉴别诊断。

Objective The present study is to assess the cardiac sympathetic nerve function in patients with Parkinson＇s disease（ PD）,multiple system atrophy（ MSA） and essential tremor（ ET） using^（131）I-MIBG myocardial scintigraphy and to explore a new method for differential diagnosis among them with expectation. Methods Twenty-five PD,eighteen MSA,eleven ET and ten normal controls were enrolled.^（131）I-MIBG myocardial scintigraphy was performed on each subject and then heart to mediastinum（ H / M） ratios were calculated at two sampled time（ 15 min and 4 h）,which represented the^（131）I-MIBG myocardial uptake ratios. Results The H / M ratios at two sampled time（ 15 min and 4 h） in the PD group were1. 65 ± 0. 36 and 1. 50 ± 0. 43,and those of the MSA group were 1. 97 ± 0. 36 and 2. 08 ± 0. 57,the ET group were 2. 34 ±0. 34 and 2. 46 ± 0. 51,and the control group were 2. 41 ± 0. 26 and 2. 66 ± 0. 47. The H / M ratios at two sampled time in the PD group were lower than those of the MSA,ET and control group respectively,with statistical significance（ all P〈0. 05）. The H / M ratios at two sampled time in the MSA group were significantly lower than those of the control group respectively（ all P〈0. 05）. There was no significant difference in H / M ratios at two sampled time between the ET and control groups（ all P〉0. 05）. Conclusion Cardiac sympathetic dysfunction could occur in both PD and MSA patients,especially in PD patients. In contrast,cardiac sympathetic function remains in ET patients. Above all,^（131）I-MIBG myocardial scintigraphy may help realize differential diagnosis among PD,MSA and ET patients.