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脑脊液 Aβ40 水平对 FTLD 与对照组的鉴别诊断具有附加价值。

Additional value of CSF amyloid-beta 40 levels in the differentiation between FTLD and control subjects.

机构信息

Department of Neurology, VU University Medical Center, Alzheimer Center Amsterdam, The Netherlands.

出版信息

J Alzheimers Dis. 2010;20(2):445-52. doi: 10.3233/JAD-2010-1392.

Abstract

To determine the additional value of cerebrospinal fluid (CSF)amyloid-beta1-40 (Abeta40) next to amyloid-beta1-42 (beta42), total tau (Tau), and tau phosphorylated at threonine-181 (pTau) to distinguish patients with frontotemporal lobar degeneration (FTLD), Alzheimer's disease (AD), and controls, we measured CSF levels of Abeta40, Abeta42, pTau, and Tau in 55 patients with FTLD, 60 with AD, and 40 control subjects. Logistic regression was used to identify biomarkers that best distinguished the groups. Additionally, a decision tree (cost=test method; Matlab 7.7) was used to predict diagnosis selecting the best set of biomarkers with the optimal cut-off. Logistic regression showed that Abeta42 and pTau CSF levels provided optimal distinction between AD and FTLD. A combination of Abeta42, Tau, and Abeta40 optimally discriminated FTLD from controls and AD from controls. The decision tree used Abeta42 (cut-off 578 pg/ml) to identify AD (positive predictive value (PPV) 97%), followed by Tau(cut-off 336 pg/ml) to identify FTLD (PPV 67%), and in the last step,Abeta40 (cut-off 10 ng/ml) was used to differentiate controls (PPV68%). Applying CSF Abeta40 levels in the model, the PPV of diagnosis increased to 75% as opposed to 70% when only Abeta42 and Tau were used. CSF Abeta40 levels added to the conventional CSF biomarkers increases the potential to discriminate subjects with dementia from controls. Our findings favor the implementation of CSF Abeta40 in differential diagnosis between FTLD, AD, and control subjects.

摘要

为了确定脑脊液(CSF)中淀粉样蛋白-β1-40(Abeta40)除淀粉样蛋白-β1-42(beta42)、总tau(Tau)和磷酸化丝氨酸-181 的 tau(pTau)以外的额外价值,以区分额颞叶变性(FTLD)、阿尔茨海默病(AD)和对照患者,我们测量了 55 例 FTLD 患者、60 例 AD 患者和 40 例对照患者的 CSF Abeta40、Abeta42、pTau 和 Tau 水平。使用逻辑回归来确定最佳区分组的生物标志物。此外,使用决策树(成本=测试方法;Matlab 7.7)来预测诊断,选择具有最佳截断值的最佳生物标志物集。逻辑回归显示 Abeta42 和 pTau CSF 水平可最佳区分 AD 和 FTLD。Abeta42、Tau 和 Abeta40 的组合可最佳区分 FTLD 与对照和 AD 与对照。决策树使用 Abeta42(截断值 578 pg/ml)来识别 AD(阳性预测值(PPV)为 97%),然后使用 Tau(截断值 336 pg/ml)来识别 FTLD(PPV 为 67%),最后使用 Abeta40(截断值 10 ng/ml)来区分对照(PPV 为 68%)。将 CSF Abeta40 水平应用于模型中,与仅使用 Abeta42 和 Tau 时的 70%相比,诊断的 PPV 增加到 75%。CSF Abeta40 水平增加到常规 CSF 生物标志物中,可提高区分痴呆患者与对照的能力。我们的发现支持在 FTLD、AD 和对照受试者之间的鉴别诊断中实施 CSF Abeta40。

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