Goldsmith Harry S
Department of Surgery, University of Nevada School of Medicine, Reno, Nevada, USA.
Ann N Y Acad Sci. 2002 Nov;977:454-67. doi: 10.1111/j.1749-6632.2002.tb04851.x.
There is increasing evidence that cerebral hypoperfusion plays a key role in the development of Alzheimer's disease (AD). As one ages, cerebral blood flow (CBF) decreases as a direct reflection of a normal aging process. Coupled with this expected drop in CBF are a host of other factors, such as hypertension, stress, smoking, diabetes, cholesterol buildup, etc., which further decrease blood flow to the brain. Maintaining a critical level of CBF is essential if adequate amounts of oxygen and glucose are to be presented to neurons to sustain their cellular energy production (ATP). If CBF drops below a critical flow level, insufficient ATP will be produced and, if this situation is not corrected, neurons will deteriorate and eventually die. When a critical mass of neurons die in areas of the brain involved with cognition and memory, AD will result. Omentum transposition to the brain is a surgical procedure by which a large volume of blood and other biological agents can be delivered to the brain over an indefinite period of time. The omentum gives metabolic support to deteriorating neurons and its presence on the brain has resulted in the reversal of AD symptoms. Additionally, omentum transposition to the brain can markedly reduce senile plaque accumulation, but has no apparent effect on reducing neurofibrillary tangles. Omental transposition may play an important role in the future treatment of AD, especially in early and moderate cases.
越来越多的证据表明,脑灌注不足在阿尔茨海默病(AD)的发展中起关键作用。随着年龄增长,脑血流量(CBF)下降,这是正常衰老过程的直接反映。除了这种预期的CBF下降外,还有许多其他因素,如高血压、压力、吸烟、糖尿病、胆固醇堆积等,这些因素会进一步减少大脑的血流量。如果要向神经元提供足够的氧气和葡萄糖以维持其细胞能量产生(ATP),维持关键水平的CBF至关重要。如果CBF降至临界血流水平以下,将产生不足的ATP,如果这种情况得不到纠正,神经元将恶化并最终死亡。当大脑中与认知和记忆相关区域的大量神经元死亡时,就会导致AD。大网膜移植到脑部是一种外科手术,通过该手术可以在不确定的时间段内向大脑输送大量血液和其他生物制剂。大网膜为恶化的神经元提供代谢支持,其在脑部的存在已导致AD症状的逆转。此外,大网膜移植到脑部可显著减少老年斑的积累,但对减少神经原纤维缠结没有明显效果。大网膜移植可能在未来AD的治疗中发挥重要作用,尤其是在早期和中度病例中。