Paraskevas G P, Kapaki E, Papageorgiou S G, Kalfakis N, Andreadou E, Zalonis I, Vassilopoulos D
Department of Neurology, School of Medicine, Athens National University, Athens, Greece.
Eur J Neurol. 2009 Feb;16(2):205-11. doi: 10.1111/j.1468-1331.2008.02387.x.
The differential diagnosis between vascular dementia (VD) and Alzheimer's disease (AD) or mixed dementia (MD) is not always easy in clinical practice. The purpose of the present study was to evaluate the cerebrospinal fluid (CSF) biomarkers tau protein in its total (tau(T)) or hyperphosphorylated at threonin-181(tau(P-181)) form and beta amyloid peptide 1-42 (A beta 42) alone and their combinations to investigate their diagnostic value in the discrimination between VD and AD or MD.
The above CSF biomarkers were determined in duplicate and blind to the clinical diagnosis by double sandwich, enzyme-linked immunosorbent assay (ELISA) commercial kits (Innogenetics, Gent, Belgium) in 92 AD patients, 23 VD patients, 17 patients with MD and 68 controls.
Alzheimer's disease and MD showed increased levels of tau(T), tau(P) and reduced levels of A beta 42 as compared with the controls. The best discrimination between VD and AD or MD was achieved by the combination of all three biomarkers, correctly classifying >or=85% of patients, either in the form of a discriminant function or in the form of the tau(T) x tau(P-181)/A beta 42 formula.
Cerebrospinal fluid biomarkers may be a useful adjunct for the discrimination between AD/ MD and VD in every day clinical practice.
在临床实践中，血管性痴呆（VD）与阿尔茨海默病（AD）或混合性痴呆（MD）之间的鉴别诊断并非总是容易的。本研究的目的是评估脑脊液（CSF）生物标志物总tau蛋白（tau(T)）或苏氨酸-181位点磷酸化的tau蛋白（tau(P-181)）以及单独的β淀粉样肽1-42（Aβ42）及其组合，以研究它们在鉴别VD与AD或MD中的诊断价值。
采用双夹心酶联免疫吸附测定（ELISA）商业试剂盒（比利时根特市Innogenetics公司），对92例AD患者、23例VD患者、17例MD患者和68例对照者的上述CSF生物标志物进行双份测定，且检测人员对临床诊断不知情。
与对照组相比，AD和MD患者的tau(T)、tau(P)水平升高，Aβ42水平降低。通过所有三种生物标志物的组合，无论是以判别函数的形式还是以tau(T)×tau(P-181)/Aβ42公式的形式，在鉴别VD与AD或MD时能达到最佳效果，正确分类患者比例≥85%。
脑脊液生物标志物可能是日常临床实践中鉴别AD/MD与VD的有用辅助手段。
