PDF(Pubmed)
Abstract：
Cardiac 123I-MIBG scintigraphy is used to assess the function of postganglionic presynaptic cardiac sympathetic nerve endings. 123I-MIBG cardiac uptake is markedly reduced in patients with isolated rapid eye movement sleep behaviour disorder, similar to Parkinson\'s disease and dementia with Lewy bodies. As a result, it can be used as an early biomarker of isolated rapid eye movement sleep behaviour disorder. Most patients with isolated rapid eye movement sleep behaviour disorder develop synucleinopathies: Parkinson\'s disease, dementia with Lewy bodies or multiple system atrophy. We aimed to investigate whether cardiac postganglionic denervation is present in patients with isolated rapid eye movement sleep behaviour disorder, as well as its possible usefulness as a marker for Lewy body disease status. This retrospective cohort study examined 306 patients (236 men and 70 women; mean age: 68.2 years; age range: 43-87 years) with polysomnography-confirmed isolated rapid eye movement sleep behaviour disorder who were followed for 1-3 months and underwent 123I-MIBG scintigraphy. We retrospectively analysed data from 306 patients with polysomnography-confirmed isolated rapid eye movement sleep behaviour disorder, and their longitudinal outcomes were documented at two centres. Among isolated rapid eye movement sleep behaviour disorder patients, reduced 123I-MIBG uptake was observed in the early and delayed images in 84.4 and 93.4% of patients, respectively, whereas 88.6% of the patients had a high washout rate. This large Japanese two-cohort study (n = 306) found that 91 patients (29.7%) developed an overt synucleinopathy (51 Parkinson\'s disease, 35 dementia with Lewy bodies, 4 multiple system atrophy, and 1 cerebellar ataxia) during a mean follow-up duration of 4.72 ± 3.94 years, with a conversion risk of 14.5% at 3 years, 25.4% at 5 years, 41.4% at 8 years and 52.5% at 10 years. On the other hand, among patients with heart-to-mediastinum ratio < 2.2 in the delayed images (n = 286), 85 (29.7%) developed Parkinson\'s disease or dementia with Lewy bodies during a mean follow-up duration of 4.71 ± 3.94 years, with a conversion risk of 14.5% at 3 years, 25.6% at 5 years, 42.0% at 8 years and 51.0% at 10 years. Among the 33 patients who underwent repeat 123I-MIBG scintigraphy, there was a progressive decline in uptake over the next 4.2 years, with patients exhibiting reduced uptake progressing to Parkinson\'s disease or dementia with Lewy bodies. In contrast, patients without decreased 123I-MIBG uptake progressed to multiple system atrophy. Reduced cardiac 123I-MIBG uptake was detected in over 90% of isolated rapid eye movement sleep behaviour disorder patients, with progression to Parkinson\'s disease or dementia with Lewy bodies, rather than multiple system atrophy, over time. Reduced 123I-MIBG uptake is a robust maker for Lewy body disease among isolated rapid eye movement sleep behaviour disorder patients.
摘要：
心脏123I-MIBG闪烁显像用于评估节后突触前心脏交感神经末梢的功能。在孤立的快速眼动睡眠行为障碍患者中，123I-MIBG心脏摄取显着降低。类似于帕金森病和路易体痴呆。因此,它可以用作孤立的快速眼动睡眠行为障碍的早期生物标志物。大多数患有孤立的快速眼动睡眠行为障碍的患者发展为突触核蛋白病：帕金森病，路易体痴呆或多系统萎缩。我们的目的是调查是否有孤立的快速眼动睡眠行为障碍患者存在心脏节后神经支配。以及它作为路易体病状态标志的可能用途。这项回顾性队列研究检查了306例患者（236例男性和70例女性；平均年龄：68.2岁；年龄范围：43-87岁）多导睡眠图证实的孤立性快速眼动睡眠行为障碍，随访1-3个月并接受了123I-MIBG闪烁显像。我们回顾性分析了306例多导睡眠图证实的孤立的快速眼动睡眠行为障碍患者的数据。在两个中心记录了他们的纵向结局.在孤立的快速眼动睡眠行为障碍患者中，84.4%和93.4%的患者在早期和延迟图像中观察到123I-MIBG摄取减少，分别,而88.6%的患者有较高的冲洗率。这项大型的日本两队列研究（n=306）发现91例患者（29.7％）发生了明显的突触核蛋白病（51例帕金森氏病，35路易体痴呆症，4多系统萎缩，和1个小脑共济失调），平均随访时间为4.72±3.94年，3年的转换风险为14.5%，5年为25.4%，8年为41.4%，10年为52.5%。另一方面,在延迟图像中心脏与纵隔比率<2.2的患者中（n=286），85（29.7％）在平均随访时间为4.71±3.94年期间发展为帕金森病或路易体痴呆，3年的转换风险为14.5%，5年为25.6%，8年为42.0%，10年为51.0%。在接受重复123I-MIBG闪烁显像的33例患者中，在接下来的4.2年里，吸收量逐渐下降，摄取减少的患者进展为帕金森病或路易体痴呆。相比之下,未减少123I-MIBG摄取的患者进展为多系统萎缩。在超过90％的孤立的快速眼动睡眠行为障碍患者中检测到心脏123I-MIBG摄取减少，随着帕金森病或路易体痴呆的进展，而不是多系统萎缩，随着时间的推移。在孤立的快速眼动睡眠行为障碍患者中，减少123I-MIBG摄取是路易体病的有力因素。
