Japanese
Title糖尿病患者に対する123I-MIBG心筋シンチグラフィによる評価 ; 自律神経障害との関連について
Subtitle原著
Authors長町茂樹*, 星博昭*, 大西隆*, 陣之内正史*, 二見繁美*, 渡邊克司*, 中津留邦展**, 年森啓隆**, 松倉茂**
Authors(kana)
Organization*宮崎医科大学放射線科, **第三内科
Journal核医学
Volume31
Number9
Page1059-1069
Year/Month1994/9
Article原著
Publisher日本核医学会
Abstract「要旨」糖尿病患者20例に対して123I-MIBG心筋シンチを施行し, その心筋集積度と自律神経障害との関連を検討した. 白律神経障害の指標には臨床症状および心電図R-R間隔の変動係数(Coefficient variance of R-R interval; CVR_R)を用い自律神経障害(-)群, 自律神経障害(+)群に分けて検討した. なお心疾患, 糖尿病を有さない8例を対照とした. 糖尿病群のPlanar早期像, 遅延像における心筋/上縦隔集積比および心筋からの洗い出し率の値は対照群と比較し有意差を認めなかった. SPECT早期像上, 糖尿病患者自律神経障害(-)群では201Tlの集積分布が正常な場合でも後下壁への123I-MIBGの集積は低下しており, 自律神経障害(+)群では集積低下部位は拡大した. また遅延像ではその傾向がさらに著明に認められた. また自律神経障害(+)群ではSPECT早期像, 遅延像いずれも後下壁/前壁集積比は対照群と比較し有意に低下していた. 自律神経障害(-)群では後下壁/前壁集積比は対照群と比較し有意差はなかったが, 後下壁の洗い出し率が対照群と比較し有意に高値を示した. 本検討により, 糖尿病患者では自律神経障害(-)の場合でも123I-MIBGの保持機構が障害され, 自律神経障害が高度になるにつれて123I-MIBGの摂取機構も障害されるものと考えられた. また本所見は特に後下壁に認められることが判明した. 糖尿病患者では, 123I-MIBG心筋シンチを用いることにより, 臨床的には自律神経障害を認めない時期から心臓交感神経異常を診断できる可能性が示唆された.
Practice臨床医学：一般
Keywords123I-MIBG, Diabetes mellitus, CVR-R, Autonomic neuropathy.
English
Title123I-MIBG Myocardial Scintigraphy in Diabetic Patients : Association with Autonomic Neuropathy
Subtitle
AuthorsShigeki NAGAMACHI*, Hiroaki HOSHI*, Takashi OHNISHI*, Seishi JINNOUCHI*, Shigemi FUTAMI*, Katsushi WATANABE*, Kuninobu NAKATSURU**, Toshitaka TOSHIMORI**, Shigeru MATSUKURA**
Authors(kana)
Organization*Department of Radiology, Miyazaki Medical College, **Third Department of Medicine, Miyazaki Medical College
JournalThe Japanese Journal of nuclear medicine
Volume31
Number9
Page1059-1069
Year/Month1994/9
ArticleOriginal article
PublisherTHE JAPANESE SOCIETY OF NUCLEAR MEDICINE
Abstract[Summary] 123I-metaiodobenzylguanidine (MIBG) myocardial scintigraphy was performed in 20 diabetic patients (NIDDM) and 8 control subjects to investigate the association between clinical autonomic nerve dysfunction and myocardial accumulation of MIBG. We used coefficient variance of R-R interval (CVR-R) as a index of the autonomic neuropathy and categorized diabetes into two groups (CVR-R>=2.0: non-autonomic neuropathy. CVR-R<2.0: autonomic neuropathy). In planar imaging studies, heart to mediastinum MIBG uptake ratio (H/M) was calculated on both early and delayed images. The washout ratio of 123I-MIBG in the heart (%WR) was also obtained using myocardial tracer activity on the both images. Mean value of these indices in diabetic group did not reveal any significant difference with the value in the control group. On the SPECT images, low uptake was observed in the posterior-inferior wall with normal uptake of 201Tl in diabetic patients with non-autonomic neuropathy. These areas extended in patients with autonomic neuropathy. The mean value of count ratio of posterior-interior to anterior wall (posterior- inferior/anterior ratio: PI/A) in the diabetic autonomic neuropathy group was significantly higher than in the control group on the both early and dealyed images. And the mean value of regional %WR in the posterior-inferior wall calculated by the both MIBG SPECT images was significantly higher in the non-autonomic neuropathy group than in the control group. In the diabetic patients, retention mechanism of 123I-MIBG was considered to be involved at an early stage without autonomic nerve dysfunction clinically. As autonomic neuropathy progressed severely, uptake mechanism was also supposed to be involved. Therefore, 123I-MIBG myocardial scintigraphy was useful for early detection of cardiac sympathetic nervous dysfunction in diabetic patients.
PracticeClinical medicine
Keywords123I-MIBG, Diabetes mellitus, CVR-R, Autonomic neuropathy.

【全文PDF】