摘要：

研究背景 由于¹³¹I-间碘苄胍（¹³¹I-MIBG）可被心脏交感神经节后纤维摄取，可作为评价心脏交感神经功能的显像剂。本研究采用¹³¹I-MIBG 心肌显像方法评价帕金森病患者心脏交感神经功能，并初步探讨该项检查方法在帕金森病早期诊断中的作用。方法 共21 例帕金森病患者（早期16 例、晚期5 例）和9 例正常对照者，采用统一帕金森病评价量表和Hoehn-Yahr 分级评价病情严重程度，静脉注射¹³¹I-MIBG 3 mCi后于不同观察时间点（15 min、4 h、24 h）采集胸部前位平面像，计算¹³¹I-MIBG 心肌摄取率。结果（1）与正常对照组相比，帕金森病组患者注射药物后15 min（1.67 ± 0.38）、4 h（1.53 ± 0.47）和24 h（1.35 ± 0.42）¹³¹I-MIBG 心肌摄取率均降低（P = 0.000，0.000，0.000）；且随着时间的推移，¹³¹I-MIBG 心肌摄取率亦降低（P = 0.002，0.000，0.000）。（2）与正常对照组相比，早期和晚期帕金森病组患者注射药物后15 min［（1.73 ± 0.40）和（1.50 ± 0.30）］、4 h［（1.58 ± 0.51）和（1.37 ± 0.31）］、24 h［（1.39 ± 0.46）和（1.24 ± 0.29）］¹³¹I-MIBG 心肌摄取率均降低（早期：P = 0.000，0.000，0.000；晚期：P = 0.000，0.000，0.000）；且随着时间的推移，早期与晚期帕金森病患者¹³¹I-MIBG 心肌摄取率亦降低（早期：P = 0.012，0.000，0.000；晚期：P = 0.039，0.001，0.024）。结论 帕金森病患者存在心脏交感神经功能障碍，且病情早期出现，¹³¹I-MIBG心肌显像可能有助于帕金森病的早期诊断。

关键词: 帕金森病, 3-碘苄胍, 放射性核素显像, 心肌, 交感神经系统

Abstract:

Background  ¹³¹I-metaiodobenzylguanidine (¹³¹I-MIBG), which can be taken by cardiac sympathetic postganglionic fibers, is an imaging agent to assess the cardiac sympathetic nerve function. The present study is to assess the cardiac sympathetic nerve function of patients with Parkinson's disease (PD) by ¹³¹I-MIBG myocardial scintigraphy and preliminarily explore its applications in the early diagnosis of PD.  Methods  Twenty-one eligible PD patients (16 early PD and 5 late PD) and 9 normal controls were enrolled in the study. Unified Parkinson's Disease Rating Scale (UPDRS) and Hoehn-Yahr stage were used to evaluate the severity of PD. Planar images of chest were obtained at different time points (15 min, 4 h and 24 h) after injection of 3 mCi ¹³¹I-MIBG, and then the ¹³¹I-MIBG myocardial uptake ratios were calculated.  Results  1) The ¹³¹I-MIBG myocardial uptake ratios in PD group at 15 min (1.67 ± 0.38), 4 h (1.53 ± 0.47) and 24 h (1.35 ± 0.42) after injection were lower than those in the normal control group respectively (P = 0.000, 0.000, 0.000), and the ¹³¹I-MIBG myocardial uptake ratios in the PD group reduced over time (P = 0.002, 0.000, 0.000). 2) The ¹³¹I-MIBG myocardial uptake ratios in the early and late PD groups at 15 min [(1.73 ± 0.40) and (1.50 ± 0.30)], 4 h [(1.58 ± 0.51) and (1.37 ± 0.31)], 24 h [(1.39 ± 0.46) and (1.24 ± 0.29)] after injection were lower than those in the normal control group respectively (early PD: P = 0.000, 0.000, 0.000; late PD: P = 0.000, 0.000, 0.000), and the ¹³¹I-MIBG myocardial uptake ratios in the early and late PD groups reduced over time (early PD: P = 0.012, 0.000, 0.000; late PD: P = 0.039, 0.001, 0.024).  Conclusions  Cardiac sympathetic nerve damage could occur in PD patients, even at an early stage of PD. ¹³¹I-MIBG myocardial scintigraphy may help in the early diagnosis of PD. 

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