Department of Psychiatry, Ludwig-Maximilian University, Alzheimer Memorial Center, Munich, Germany.
CNS Neurosci Ther. 2009 Winter;15(4):358-74. doi: 10.1111/j.1755-5949.2009.00104.x. Epub 2009 Oct 14.
At the earliest clinical stages of Alzheimer's disease (AD), when first symptoms are mild, making a reliable and accurate diagnosis is difficult. AD related brain pathology and underlying molecular mechanisms precede symptoms. Biological markers can serve as supportive early screening and diagnostic tools as well as indicators of presymptomatic biochemical change. Moreover, biomarkers cover a variety of roles and functions such as disease prediction, indicating disease acuity and progression, and may ensure biological mapping of treatment outcome. Early screening, detection, and diagnosis of AD would permit earlier disease modifying intervention at potentially reversible stages. To date, most established biological markers from both cerebrospinal fluid neurochemistry and structural and functional neuroimaging have not reached widespread clinical application. Crucial remaining problems, such as easy acceptance and application of a test, cost-effectiveness, and noninvasiveness, need to be resolved. The development and validation of precise, reliable, and robust tests and biomarkers in blood, plasma, or serum has therefore been for a long time the ultimate focus of many research groups worldwide. Blood-based testing will most likely be the prerequisite to future sensitive screening of large populations at risk of AD and the baseline in a diagnostic flow approach to AD. The status and emerging perspectives on hypothesis and exploratory-based candidate biomarkers derived from blood, plasma, and serum are reviewed and discussed.
在阿尔茨海默病(AD)的最早临床阶段,当最初的症状很轻微时,做出可靠和准确的诊断是很困难的。AD 相关的大脑病理学和潜在的分子机制先于症状出现。生物标志物可以作为支持性的早期筛查和诊断工具,以及预示无症状生化变化的指标。此外,生物标志物具有多种作用和功能,如疾病预测、指示疾病严重程度和进展,并可能确保治疗效果的生物学映射。早期筛查、检测和诊断 AD 可以在潜在可逆转的阶段更早地进行疾病修饰干预。迄今为止,来自脑脊液神经化学以及结构和功能神经影像学的大多数已确立的生物标志物都尚未广泛应用于临床。仍然存在一些关键问题,例如测试的易于接受和应用、成本效益和非侵入性,需要解决。因此,开发和验证精确、可靠和稳健的血液、血浆或血清检测和生物标志物一直是全球许多研究小组的最终关注点。基于血液的检测很可能是未来对 AD 高危人群进行敏感筛查的前提,也是 AD 诊断流程方法的基线。本文综述并讨论了源自血液、血浆和血清的基于假说和探索性的候选生物标志物的现状和新兴观点。