Cardiac sympathetic denervation in early stages of amyotrophic lateral sclerosis demonstrated by 123I-MIBG-SPECT
Cardiac sympathetic denervation in early stages of amyotrophic lateral sclerosis demonstrated by 123I-MIBG-SPECT
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DOI：
10.1111/j.1600-0404.1999.tb00681.x
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发表时间：
1999-05-01
影响因子：
3.5
通讯作者：
Neundörfer, B
中科院分区：
文献类型：
--
作者：
Druschky, A;Spitzer, A;Neundörfer, B
对40例肌萎缩侧索硬化症(ALS)早期患者的心脏自主神经系统受累情况进行了评估。I-123-间苯并基胍-单光子发射计算机断层扫描(MIBG-SPECT)和心率变异性(HRV)提供了心脏交感和副交感神经支配的信息。MIBG-SPECT是显示早期心脏交感神经支配的敏感诊断方法。40例患者中有16例(40%)同时存在交感神经和副交感神经功能障碍。心脏/纵隔比值显示，所有ALS患者的心脏MIBG摄取均显著低于对照组(P<；0.01)。全球MIBG-SPECT评分明显异常的占29%，轻微异常的占22%。38例患者中有6例HRV降低，其中4例MIBG-SPECT评分也异常。这些结果表明，ALS患者有轻到中度的损害，可能有节后交感神经肾上腺素能心脏或心脏迷走神经失神经的证据。据我们所知，这是第一个表明ALS可能有节后交感神经支配的研究。肌萎缩侧索硬化症最初的概念是运动神经元的孤立变性，这似乎延伸到了对这种疾病的更广泛的理解，可能代表不同的实体。
Involvement of the autonomic cardiac nervous system in early stages of amyotrophic lateral sclerosis (ALS) was evaluated in 40 patients. I-123-metaiodobenzylguanidine-single photon emission computed tomography (MIBG-SPECT) and heart rate variability (HRV) yielded information about sympathetic and parasympathetic innervation of the heart. MIBG-SPECT is a sensitive diagnostic method for demonstration of early cardiac sympathetic denervation. Both sympathetic and parasympathetic dysfunction was observed in 16 (40%) out of 40 patients. Mean cardiac MIBG uptake as demonstrated by the heart/mediastinum ratio was significantly reduced in all ALS patients in comparison with controls (P < 0.01). The global MIBG-SPECT score was clearly abnormal in 29% and slightly abnormal in 22% of patients. HRV was diminished in 6 of 38 patients, 4 of whom having an abnormal MIBG-SPECT score as well. The presented results indicate that ALS patients with mild to moderate impairment may have evidence of postganglionic sympathetic adrenergic cardiac or cardiovagal denervation. To our knowledge, this is the first study indicating possible postganglionic sympathetic denervation in ALS. The original concept of ALS as an isolated degeneration of motor neurons seems to extend to a more widespread understanding of the disease which possibly represents different entities.