Perfuziona scintigrafija donjih ekstremiteta sa 99mTc-MIBI i određivanje endotelina kod bolesnika sa dijabetesom melitusom i kod zdravih ispitanika

  • Nevena Manevska Ss. Cyril and Methodius University, Institute of Pathophysiology and Nuclear Medicine, Skopje, Northern Macedonia
  • Sinisa Stojanoski Ss. Cyril and Methodius University, Institute of Pathophysiology and Nuclear Medicine, Skopje, Northern Macedonia
  • Irfan Ahmeti Ss. Cyril and Methodius University, Institute of Pathophysiology and Nuclear Medicine, Skopje, Northern Macedonia
  • Toni Tripunoski Ss. Cyril and Methodius University, Institute of Pathophysiology and Nuclear Medicine, Skopje, Northern Macedonia
  • Daniela Pop Gjorceva Ss. Cyril and Methodius University, Institute of Pathophysiology and Nuclear Medicine, Skopje, Northern Macedonia
  • Venjamin Majstorov Ss. Cyril and Methodius University, Institute of Pathophysiology and Nuclear Medicine, Skopje, Northern Macedonia
  • Gordana Pemovska Ss. Cyril and Methodius University, Institute of Pathophysiology and Nuclear Medicine, Skopje, Northern Macedonia
DOI: https://doi.org/10.2298/VSP171001115M
Ključne reči: dijabetes melitus, insulin nezavisni;, bolest perifernih arterija;, perfuziono snimanje;, noga;, endotelin-1

Sažetak


Uvod/Cilj. Bolest perifernih arterija predstavlja makrovaskularnu komplikaciju dijabetesa melitusa (DM) koja nastaje kao zbog poremećaja homeostatskih mehanizama endotelijuma i kojom započinje proces arterioskleroze. Poremećaj ravnoteže vazodilatatora endotelnog porekla i vazokonstriktora ima veliku ulogu u patogenezi dijabetičke mikroangiopatije, kao i ostalih vaskularnih komplikacija dijabetesa. Cilj rada je bio da se uporede rezultati dinamičkih i statičkih studija perfizione scintigrafije donjih ekstremiteta sa tehnecijum-99m-metoksiizobutil izonitrilom (99m-Tc–MIBI) (jednodnevni stres/oporavak test) kod osoba sa DM i kod zdravih ispitanika u cilju određivanja perfuzine rezerve u okviru dijagnostičke evaluacije bolesti perifernih arterija kod osoba sa DM tip 2, kao i da se odredi nivo endotelina-1 (ET-1) kao vazokonstriktora kod osoba sa i bez DM. Metode. Prospektivnom studijom obuhvaćeno je 90 ispitanika podeljenih u dve grupe prema prisustvu ( DP)/odsustvu DM tip 2 (NDP). DP grupu sačinjavalo je 60/90 (67%) bolesnika sa DM tip 2, dok je u grupi NDP bilo 30/90 (33%) ispitanika bez DM tip 2. Perfuziona scintigrafija sa 99mTc-MIBI mišićnog tkiva donjih ekstremiteta sprovedena je u fazi odmora i fazi stresa. Rezultati. U DP grupi ustanovljen je značajno niži pik radioaktivosti u odnosu na NDP grupu ispitanika obostrano i u obe faze sa nižim inter-extremity indeksima i sniženom perfuzionom rezervom. Utvrđena je značajna razlika u koncentraciji ET-1 između grupa (veća koncentracija je zabeležena u DP grupi). Zaključak. Prikazani jednodnevni protokol perfizione scintigrafije donjih ekstremiteta u fazi odmora i napora je korisna procedura u proceni bolesti perifernih arterija bolesnika sa DM tip 2, naročito u asimptomatskoj formi bolesti.

Reference

Davignon J, Ganz P. Role of endothelial dysfunction in athero-sclerosis. Circulation 2004; 109(23 Suppl 1): III27–32.

Creager MA, Luscher TF, Cosentino F, Beckman JA. Diabetes and vascular disease: pathophysiology, clinical consequences, and medical therapy: Part I. Circulation 2003; 108(12): 1527–32.

Luscher TF, Creager MA, Beckman JA, Cosentino F. Diabetes and vascular disease: pathophysiology, clinical consequences, and medical therapy: Part II. Circulation 2003; 108(13): 1655–61.

Bohm F, Pernow J. The importance of endothelin-1 for vascular dysfunction in cardiovascular disease. Cardiovasc Res 2007; 76(1): 8–18.

Olin JW, Sealove BA. Peripheral artery disease: current insight into the disease and its diagnosis and management. Mayo Clin Proc 2010; 85(7): 678–92.

Arbab AS, Koizumi K, Toyama K, Arai T, Araki T. Effects of ion channel modulators in the influx and efflux of Tc-99m-MIBI. Ann Nucl Med 1999; 13(1): 27–32.

Piwnica-Worms DP, Kronauge JF, LeFurgey A, Backus M, Hockett D, Ingram P, et al. Mitochondrial localization and characteriza-tion of 99Tc-SESTAMIBI in heart cells by electron probe X-ray microanalysis and 99Tc-NMR spectroscopy. Magn Reson Imaging 1994; 12(4): 641–52.

Piwnica-Worms D, Kronauge JF, Chiu ML. Uptake and Reten-tion of Hexakis (2-Methoxyisobutyl Isonitrile) Technetium(I) in Cultured Chick Myocardial Cells Mitochondrial and Plasma Membrane Potential Dependence. Circulation 1990; 82(5): 1826–38.

Taillefer R. Technetium-99m sestamibi myocardial imaging: same-day stress-rest studies and dipyridamole. Am J Cardiol 1990; 66(13): 80E-84E.

Cosson E, Paycha F, Tellier P, Sachs RN, Ramadan A, Paries J, et al. Lower-Limb Vascularization in Diabetic Patients: Assess-ment by thallium-201 scanning coupled with exercise myocar-dial scintigraphy. Diabetes Care 2001; 24(5): 870–4.

Lin CC, Ding HJ, Chen YW, Huang WT, Kao A. Usefulness of thallium-201 muscle perfusion scan to investigate perfusion reserve in the lower limbs of Type 2 diabetic patients. J Diabe-tes Complications 2004; 18(4): 233–6.

Cizmić M, Pucar D, Zoranović U. Assesment of lower extremities ischemic disease by thallium 201 perfusion scintigraphy in pa-tients with diabetic angiopathy. Vojnosanit Pregl 2011; 68(2): 161–5. (Serbian)

Younes JA, El-Sayed ND, Kamel AI. Prevalence of Subclinical Peripheral Vascular Disease in Obese Egyptian Patients. Indi-an J Nucl Med 2017; 32(4): 271–8.

Soyer H, Uslu I. A patient with peripheral arterial stenosis di-agnosed with lower extremity perfusion scintigraphy. Clin Nucl Med 2007; 32(6): 458–9.

Manevska N, Gjorceva DP, Ahmeti I, Todorovska L, Stojanoski S, Kocovska MZ. Tissue-Muscle Perfusion Scintigraphy of the Lower Limbs in a Patient with Type 2 Diabetes Mellitus and Peripheral Arterial Disease. Mol Imaging Radionucl Ther 2016; 25(1): 42–6.

Tan YZ, Kılıç S, Temiz A, Özdemir S, Kurt T, Cevizci S. Com-parison of Ankle-Brachial Index and Lower Limb Perfusion Reserve in Patients with Behçet’s Disease. Austin J Nucl Med Radiother 2016; 3(1): 1015.

Amin AM, Nawito ZO, Atfy RA, El-Hadidi KT. Tc-99m sesta-mibi lower extremity muscle scan, is it a useful screening tool for assessment of preclinical atherosclerosis in rheumatoid ar-thritis patients? Rheumatol Int 2012; 32(7): 2075–81.

Tooke JE. Possible pathophysiological mechanisms for diabetic angiopathy in type 2 diabetes. J Diabetes Complications 2000; 14(4): 197–200.

Jansson PA. Endothelial dysfunction in insulin resistance and type 2 diabetes. J Intern Med 2007; 262(2): 173–83.

Rask-Madsen C, King GL. Mechanisms of disease: endothelial dysfunction in insulin resistance and diabetes. Nat Clin Pract Endocrinol Metab 2007; 3(1): 46–56.

Objavljeno
2021/04/12
Broj časopisa
Vol. 77 Br. 7 (2020): Vojnosanit Pregl
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Originalni članak