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首页> 外文期刊>Sarcoidosis, vasculitis, and diffuse lung diseases: official journal of WASOG >Association of small fiber neuropathy with cardiac sympathetic dysfunction in sarcoidosis.
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Association of small fiber neuropathy with cardiac sympathetic dysfunction in sarcoidosis.

机译：结节病中小纤维神经病变与心脏交感神经功能障碍的关系。

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BACKGROUND AND AIM: Recently we found that small fiber neuropathy (SFN) occurs frequently in sarcoidosis. Autonomic dysfunction may be a feature of SFN. Since cardiac autonomic dysfunction has been identified as a strong predictor of morbidity and mortality, recognition of cardiac autonomic involvement is of clinical relevance. It was hypothesised that SFN might be related to cardiac sympathetic denervation in sarcoidosis. METHODS: In the present study 45 consecutive sarcoidosis patients (13 without SFN assessed by thermal threshold testing (TTT), 32 with SFN (abnormal TTT) were enrolled. To rule out bias due to myocardial ischemia, cases with abnormal Thallium (201Tl) perfusion scintigraphy were excluded (n = 2). Cardiovascular autonomic function testing (Ewing tests) and 123I-MIBG (metaiodobenzylguanidine) scintigraphy were used to assess cardiac autonomic function. Further cardiac diagnostic work-up included ECG, Holter recording and echo Doppler cardiography. RESULTS: Mild to moderate heterogeneityof 123I-MIBG uptake regional in the myocardium was demonstrated in a substantial number of the studied sarcoidosis population, especially in those with SFN (abnormal TTT). Mean inferior-anterior ratios were 0.85+/-0.17 (SFN) and 1.0+/-0.17 (no SFN; p = 0.003), respectively. Four out of the 14 cases with abnormal MIBG scintigraphy and SFN showed an abnormal Ewing test. CONCLUSION: Cardiac sympathetic dysfunction assessed by use of 123I-MIBG myocardial scanning appeared to be heterogeneous in sarcoidosis patients and dependent on the presence or absence of SFN. MIBG scintigraphy may be of additional value in the management and follow-up of sarcoidosis patients. Future study is warranted to explore possible prognostic and therapeutic implications of these findings in sarcoidosis.
机译：背景与目的：最近，我们发现结节病中经常发生小纤维神经病变（SFN）。自主神经功能障碍可能是SFN的特征。由于心脏自主神经功能障碍已被确定为发病率和死亡率的重要预测指标，因此认识到心脏自主神经受累具有临床意义。假设SFN可能与结节病中的心脏交感神经失调有关。方法：本研究共入选了45例结节病患者（其中13例未通过热阈值测试（TTT）评估为SFN，32例为SFN（异常TTT），为排除因心肌缺血引起的偏倚，hall灌注（201Tl）异常。排除了心电图检查（n = 2），使用了心血管自主功能检查（尤因试验）和123I-MIBG（甲氧​​苄苄胍）进行了心电图检查，进一步进行了心脏诊断检查，包括心电图，动态心电图记录和回波多普勒心电图检查。 ：在大量研究的结节病人群中，尤其是那些患有SFN（异常TTT）的人群中，证实了心肌中123I-MIBG摄取区域的轻度至中度异质性，平均前下比为0.85 +/- 0.17（SFN）， 1.0 +/- 0.17（无SFN; p = 0.003），在14例MIBG闪烁显像和SFN异常的病例中，有4例表现出尤因试验异常。结论：心脏交感神经功能障碍在结节病患者中使用123I-MIBG心肌扫描评估的异质性似乎是异质的，并且取决于SFN的存在与否。 MIBG闪烁显像在结节病患者的治疗和随访中可能具有附加价值。有必要进行进一步的研究以探讨结节病中这些发现的可能的预后和治疗意义。

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