Röcken C, Ernst J, Hund E, Michels H, Perz J, Saeger W, Sezer O, Spuler S, Willig F, Schmidt H H-J
Institut für Pathologie, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin.
Dtsch Med Wochenschr. 2006 Jul 7;131(27 Suppl 2):S45-66. doi: 10.1055/s-2006-947836.
Within the past 10 years, a new range of knowledge has been achieved in the field of amyloidosis, especially with regard to pathogenesis, diagnosis and therapy. Amyloidosis leads to variable and distinct symptoms and is caused by different underlying conditions. Some amyloidoses are acquired secondary to a chronic condition; others are caused by genetic mutations. Amyloid and amyloidosis occur more frequently than they are perceived. Among the frequent localized forms are the cerebral amyloidosis linked to Alzheimer disease (AD) and the pancreatic amyloidosis linked to diabetes mellitus. Among the most frequent systemic (extracerebral) forms is AL amyloidosis, which often has a poor prognosis and if untreated can rapidly lead to death. Systemic amyloidosis that happen at infancy are mainly AA amyloidosis that can progress to death already at early or at middle adulthood. Amyloidosis can be treated but therapeutic success significantly depends upon early diagnosis and proper classification of the amyloid type. It is mandatory that differential diagnosis demonstrate the presence of amyloid and clearly identify the type of the disease. Development of methods and techniques have contributed to improvements in the diagnosis and treatment. Early diagnosis and proper classification of amyloid is decisive for therapeutic options and upon them depend quality of life and mortality. The therapeutic spectrum is various and includes organ transplantation, chemotherapy, and anti-inflammatory strategies. Gene therapy and biological active substances have to be considered in the near future.
在过去10年里,淀粉样变性领域取得了一系列新的知识,特别是在发病机制、诊断和治疗方面。淀粉样变性会导致各种不同的症状,由不同的潜在病因引起。一些淀粉样变性是继发于慢性疾病;另一些则由基因突变导致。淀粉样蛋白和淀粉样变性的发生频率比人们认为的更高。常见的局限性形式包括与阿尔茨海默病(AD)相关的脑淀粉样变性和与糖尿病相关的胰腺淀粉样变性。最常见的全身性(脑外)形式是AL淀粉样变性,其预后通常较差,若不治疗可迅速导致死亡。婴儿期发生的全身性淀粉样变性主要是AA淀粉样变性,在成年早期或中期就可能进展至死亡。淀粉样变性可以治疗,但治疗成功与否很大程度上取决于早期诊断和对淀粉样蛋白类型的正确分类。鉴别诊断必须证明淀粉样蛋白的存在并明确疾病类型。方法和技术的发展有助于诊断和治疗的改进。淀粉样变性的早期诊断和正确分类对治疗选择起决定性作用,而治疗选择又决定着生活质量和死亡率。治疗方法多种多样,包括器官移植、化疗和抗炎策略。在不久的将来还需考虑基因治疗和生物活性物质。