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帕金森病(parkinson disease,PD)是中老年人群中第2大常见的神经系统变性疾病,其病因为α突触核蛋白在神经元内沉积、大脑和心脏中缺乏儿茶酚胺类的多巴胺及去甲肾上腺素[1-2]。PD的临床表现主要分为运动症状和非运动症状两大类。运动症状包括行动迟缓、静止性震颤、肌强直和姿势紊乱等[3];非运动症状包括感觉障碍、睡眠障碍、认知精神障碍及自主神经功能障碍等[4]。PD的诊断主要依赖于临床表现,诊断和鉴别诊断较为困难,目前尚无统一的诊断标准。
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心脏功能由自主神经系统的交感神经和副交感神经双重支配,均通过神经末梢释放神经递质作用于心肌细胞浆膜中的受体,从而调节心肌功能。交感神经末梢释放去甲肾上腺素和肾上腺素,从而作用于心肌细胞中占主导地位的β肾上腺素能受体;副交感神经末梢释放乙酰胆碱作用于心肌中的毒蕈碱受体[5]。酪氨酸羟化酶(tyrosine hydroxylase,TH)是儿茶酚胺生物合成中的限速酶,也是儿茶酚胺能神经元的生物标志物,MIBG心肌显像会显示TH的水平[6]。Kuten等[7]发现,在PD患者心外膜神经中,TH免疫反应降低,80%~90%的PD患者会出现心脏交感神经变性,可通过心脏神经受体显像进行可视化。心脏神经受体显像能直观显示心脏交感神经的完整性和功能状态,有助于诊断和鉴别诊断早期PD,因此临床上将心脏交感神经支配的影像学检查结果作为支持性诊断标准[8]。我们就心脏神经受体显像在诊断与鉴别诊断PD中的研究进展进行综述。
帕金森病心脏神经受体显像的最新研究进展
Recent research progress of cardiac neroreceptor imaging in parkinson disease
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摘要: 帕金森病(PD)是中老年人群中第2大常见的神经系统变性疾病。迄今为止,临床上尚无有效方法治疗这种慢性疾病。心脏神经受体显像可以直观显示心脏交感神经的完整性和功能状态,是评价心脏交感神经功能的灵敏指标,对诊断和鉴别诊断早期PD尤为重要。笔者重点阐述了心脏神经受体显像在诊断与鉴别诊断PD中的最新研究进展。Abstract: Parkinson disease (PD) is the second most common neurodegenerative disease in middle-aged and elderly people. To date, there is no effective treatment methods for this chronic disease in clinical. Cardiac neuroreceptor imaging can visualize the integrity and functional status of cardiac sympathetic nerves, it is a sensitive indicator for evaluating cardiac sympathetic nerve function, which is particularly important for the diagnosis and differential diagnosis of early PD. The authors focused on the latest progress research of cardiac neuroreceptor imaging in the diagnosis and differential diagnosis of PD.
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