^(123)I-MIBG显像对帕金森病早期诊断的临床价值

Clinical value of ^(123)I-MIBG imaging in early diagnosis of Parkinson's disease

目的对比分析帕金森病(PD)患者唾液腺及心脏间碘苄胍显像(MIBG)摄取率,并与临床分级及帕金森运动量表进行分析,探讨PD早期、特异的诊断方法。方法回顾性分析2019年6月至2020年5月于首都医科大学附属北京友谊医院就诊PD患者31例的临床资料,其中男性18例,女性13例,平均年龄(66.5±8.9岁),将其作为PD组;同时选取正常人5例,其中男性3例,女性2例,平均年龄(68.6±5.4)岁,作为正常对照组。采用PD统一评分量表UPDRS-Ⅲ及Hoehn-Yahr(H-Y)分级评价2组对象的运动能力及病情严重程度。所有患者行123 I-MIBG显像,分别采集15 min及4 h心肌及唾液腺平面像,并勾画感兴趣区,获得早期显像腮腺、颌下腺及心肌摄取率(P/B 15 min、S/B 15 min、H/M 15 min)及延迟显像腮腺、颌下腺及心肌摄取率(P/B 4 h、S/B 4 h、H/M 4 h)。与正常对照组比较,分析PD患者不同时间点唾液腺及心脏交感神经变化情况。结果与正常对照组比较,PD组P/B 15 min及S/B 15 min分别为1.83±0.53、2.51±0.67;对照组P/B 15 min及S/B 15 min分别为1.84±0.79、2.40±0.87。PD组P/B 4 h及S/B 4 h分别为1.73±0.49、2.19±0.52;对照组P/B 4 h及S/B 4 h分别为2.10±0.57、2.52±0.63。H/M 15 min PD组为1.41±0.18,对照组为1.89±0.10;H/M 4 h PD组为1.34±0.24,对照组为1.98±0.22。PD组腮腺及颌下腺交感神经分布及活性未见明显减低,差异无统计学意义(P>0.05),而心脏交感神经分布及活性明显减低,差异有统计学意义(P<0.05)。PD患者心肌MIBG摄取率明显减低,且随H-Y分级及运动症状加重,H/M4 h比值降低更为明显。结论PD患者心脏MIBG摄取率明显降低,且随运动症状及H-Y分级加重。MIBG延迟显像可提高PD早期诊断特异性。PD患者有无唾液腺交感神经受损尚需进一步研究。

Objective Investigated the difference of salivary gland and cardiac metaiodobenzylguanidine(MIBG)uptake between Parkinson's disease(PD)and normal controls,and further analyzed with UPDRS scale and Hoehn-Yahr staging to search for early and specific diagnostic methods of Parkinson's disease.Methods A total of 31 patients with PD,18 males,13 females,average age(66.5±8.9)years who were admitted to Beijing Friendship Hospital,Capital Medical University from June 2019 to May 2020 were retrospectively analyzed and regarded as the PD group.And 5 normal people,3 males,2 females,average age(68.6±5.4)years,were regarded as the normal control group.The UPDRS and Hoehn-Yahr(H-Y)staging were used to evaluated the motor symptoms and severity of 2 groups of research objects.All patients underwent 123 I-MIBG scintigraphy.Early and delayed salivary and cardiac images were obtained after 15 min and 4 h.Region of interest(ROI)were drawn around parotid gland,submandibular gland and heart on planar image,the quantitative parameters of P/B 15 min,S/B 15 min,H/M 15 min,P/B 4 h,S/B 4 h and H/M 4 h were obtained.We further assessed the relationship between MIBG uptake,UPDRS scale and H-Y staging.Results Comparing with the normal control,PD group P/B 15 min and S/B 15 min were 1.83±0.53,2.51±0.67,respectively,and control group P/B 15 min and S/B 15 min were 1.84±0.79,2.40±0.87,respectively.PD group P/B 4 h and S/B 4 h were1.73±0.49,2.19±0.52,respectively,while normal control group P/B 4 h and S/B 4 h were 2.10±0.57,2.52±0.63,respectively.The distribution and activity of sympathetic nerves in the parotid and submandibular glands were not significantly reduced in the PD group,the difference was not statistically significant(P>0.05);while the distribution and activity of sympathetic in the heart were significantly reduced,the difference was statistically significant(P<0.05).The early and delay H/M ratios were decreased with high H-Y staging in PD patients.Conclusion Our findings demonstrated cardiac MIBG uptake was significant decreased,and have negative relation to UPDRS scale and H-Y staging.Cardiac delay imaging of 123 I-MIBG scintigraphy was sufficient to improve the diagnostic performance.Further research is needed to determine whether impaired the sympathetic of salivary gland in PD.