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脑脊液生物标志物在阿尔茨海默病诊断标准演变中的作用:前驱期诊断的不足

The Role of Cerebrospinal Fluid Biomarkers in the Evolution of Diagnostic Criteria in Alzheimer's Disease: Shortcomings in Prodromal Diagnosis.

作者信息

Szalárdy Levente, Zádori Dénes, Klivényi Péter, Vécsei László

机构信息

Department of Neurology, Faculty of Medicine, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary.

MTA-SZTE Neuroscience Research Group, Szeged, Hungary.

出版信息

J Alzheimers Dis. 2016 May 7;53(2):373-92. doi: 10.3233/JAD-160037.

Abstract

The available evidence indicates a high performance of core cerebrospinal fluid (CSF) biomarkers in differentiating between Alzheimer's disease (AD) and other dementias, and suggests that their characteristic alterations can be detected even at the prodromal stage of AD. On this basis, the ability of core CSF biomarkers to identify prodromal AD patients from pre-dementia of all causes can be postulated, a concept that is reflected in recent revisions of AD research criteria and a consensus statement. Following an overview on the role of biomarkers in the evolution of diagnostic criteria of AD in recent decades, this paper provides a critical review of the widely applied CSF biomarker study designs and evaluating approaches that address the ability of core CSF biomarkers to diagnose prodromal AD, with special focus on their potential limitations in terms of clinical interpretation and utility. The findings together raise the question of whether we are indeed able to establish a CSF biomarker-based diagnosis of AD at the prodromal stage.

摘要

现有证据表明,核心脑脊液(CSF)生物标志物在区分阿尔茨海默病(AD)与其他痴呆症方面具有很高的性能,并表明即使在AD的前驱期也能检测到其特征性改变。在此基础上,可以推测核心CSF生物标志物能够从各种原因导致的痴呆前状态中识别出前驱期AD患者,这一概念反映在AD研究标准的最新修订版和一份共识声明中。在概述生物标志物在近几十年来AD诊断标准演变中的作用之后,本文对广泛应用的CSF生物标志物研究设计和评估方法进行了批判性综述,这些设计和方法旨在探讨核心CSF生物标志物诊断前驱期AD的能力,特别关注其在临床解释和实用性方面的潜在局限性。这些发现共同提出了一个问题,即我们是否真的能够在前驱期建立基于CSF生物标志物的AD诊断。

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