Department of Biomedical Sciences, Reference Center for Biological Markers of Dementia (BIODEM), University of Antwerp, and Department of Neurology and Memory Clinic, Hospital Network Antwerp (ZNA) Middelheim and Hoge Beuken, Antwerp, Universiteitsplein 1, 2610 Antwerp, Belgium.
Rev Neurol (Paris). 2013 Oct;169(10):709-14. doi: 10.1016/j.neurol.2013.07.024. Epub 2013 Sep 6.
The cerebrospinal fluid (CSF) biomarkers β-amyloid1-42 (Aβ1-42), total tau protein (T-tau) and hyperphosphorylated tau (P-tau181P) are well-validated and are increasingly used in clinical practice as an affirmative diagnostic tool for Alzheimer's disease (AD). These biomarkers have also been implemented in the revised diagnostic criteria of AD. The combination of the CSF biomarkers Aβ1-42, T-tau and P-tau181P results in high levels of sensitivity, specificity and diagnostic accuracy for discriminating AD from controls (including psychiatric disorders like depression). These biomarkers can be applied for diagnosing AD in the prodromal phase of the disease (mild cognitive impairment). In case of doubt between vascular dementia (VaD) or mixed AD-VaD pathology in dementia patients, the determination of CSF Aβ1-42, T-tau and P-tau181P levels is of help to confirm or exclude the AD component in the pathophysiology of the dementia syndrome. However, their discriminatory power for the differential diagnosis of dementia is suboptimal. Other CSF biomarkers like Aβ1-40, and those that are reflective of the pathology of non-AD dementias, could improve the accuracy of differential dementia diagnosis. The added differential diagnostic value of the CSF biomarkers Aβ1-42, T-tau and P-tau181P could lie within those cases in which the routine clinical diagnostic work-up is not able to discriminate between AD or non-AD dementias. In summary, the CSF biomarkers Aβ1-42, T-tau and P-tau181P can be used in clinical practice to discriminate AD from healthy aging (including psychiatric disorders like depression), to diagnose AD in its prodromal phase or in atypical forms with prominent non-memory impairment, to identify AD in patients with mixed pathologies and in case of an ambiguous (AD versus non-AD) dementia diagnosis.
脑脊液(CSF)生物标志物β-淀粉样蛋白 1-42(Aβ1-42)、总tau 蛋白(T-tau)和磷酸化 tau(P-tau181P)经过了充分验证,并越来越多地被用于临床实践,作为阿尔茨海默病(AD)的肯定性诊断工具。这些生物标志物也已被纳入 AD 的修订诊断标准。CSF 生物标志物 Aβ1-42、T-tau 和 P-tau181P 的组合可实现高灵敏度、特异性和诊断准确性,用于区分 AD 与对照(包括抑郁症等精神障碍)。这些生物标志物可用于诊断疾病的前驱期(轻度认知障碍)AD。在痴呆患者中,当血管性痴呆(VaD)或混合 AD-VaD 病理学之间存在疑问时,确定 CSF Aβ1-42、T-tau 和 P-tau181P 水平有助于确认或排除痴呆综合征病理生理学中的 AD 成分。然而,它们在痴呆症鉴别诊断中的区分能力并不理想。其他 CSF 生物标志物,如 Aβ1-40,以及那些反映非 AD 痴呆病理的标志物,可提高鉴别诊断的准确性。CSF 生物标志物 Aβ1-42、T-tau 和 P-tau181P 的附加鉴别诊断价值可能在于常规临床诊断检查无法区分 AD 或非 AD 痴呆的情况下。总之,CSF 生物标志物 Aβ1-42、T-tau 和 P-tau181P 可在临床实践中用于区分 AD 与健康衰老(包括抑郁症等精神障碍)、诊断前驱期 AD 或伴有突出非记忆障碍的不典型形式 AD、在混合病理学患者中识别 AD 以及在(AD 与非 AD)痴呆诊断不明确的情况下。
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