阿尔茨海默病合并多发性脑微出血及脑淀粉样血管病相关炎症患者的脑脊液特征比较

Comparison of cerebrospinal fluid profiles in Alzheimer's disease with multiple cerebral microbleeds and cerebral amyloid angiopathy-related inflammation.

作者信息

Kimura Akio, Takemura Masao, Saito Kuniaki, Yoshikura Nobuaki, Hayashi Yuichi, Harada Naoko, Nishida Hiroshi, Nakajima Hideto, Inuzuka Takashi

机构信息

Department of Neurology and Geriatrics, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu, 501-1194, Japan.

Department of Informative Clinical Medicine, Gifu University Graduate School of Medicine, Gifu, Japan.

出版信息

J Neurol. 2017 Feb;264(2):373-381. doi: 10.1007/s00415-016-8362-2. Epub 2016 Dec 20.

Abstract

Brain magnetic resonance imaging (MRI) of patients with Alzheimer's disease (AD) sometimes reveals multiple cerebral microbleeds (CMBs) and confluent white matter hyperintensities (WMHs) similar to those observed in cerebral amyloid angiopathy-related inflammation (CAA-I). To determine whether there might be common pathophysiological mechanisms underlying the MRI findings of multiple CMBs and confluent WMHs, we investigated the cerebrospinal fluid (CSF) profiles of 38 AD, five amnestic mild cognitive impairment (MCI), and six CAA-I patients. The AD and MCI patients were divided into groups of patients with (n = 10) or without (n = 33) multiple CMBs (n ≥ 2) on T2*-gradient echo sequences of brain MRI. We compared the CSF profiles of AD and MCI patients with or without multiple CMBs, and CAA-I patients. The brain MRIs of the patients with multiple CMBs revealed severe degrees of WMHs compared with the patients without multiple CMBs. The levels of CSF anti-amyloid β autoantibody and interleukin 8, and CSF/serum albumin ratios and immunoglobulin G indexes, were significantly higher in CAA-I patients than the other groups. However, there were no significant differences in the CSF profiles of patients with or without multiple CMBs. Our study provides evidence for different pathophysiological mechanisms underlying these differential MRI findings in AD and CAA-I.

摘要

阿尔茨海默病(AD)患者的脑磁共振成像(MRI)有时会显示出多发性脑微出血(CMB)和融合性白质高信号(WMH),类似于在脑淀粉样血管病相关炎症(CAA-I)中观察到的情况。为了确定多发性CMB和融合性WMH的MRI表现背后是否可能存在共同的病理生理机制,我们调查了38例AD患者、5例遗忘型轻度认知障碍(MCI)患者和6例CAA-I患者的脑脊液(CSF)特征。AD和MCI患者根据脑MRI的T2 *梯度回波序列上是否存在多发性CMB(n≥2)分为两组(n = 10)或无多发性CMB组(n = 33)。我们比较了有或没有多发性CMB的AD和MCI患者以及CAA-I患者的CSF特征。与没有多发性CMB的患者相比,有多发性CMB的患者的脑MRI显示出更严重程度的WMH。CAA-I患者的脑脊液抗淀粉样β自身抗体和白细胞介素8水平,以及脑脊液/血清白蛋白比率和免疫球蛋白G指数,均显著高于其他组。然而,有或没有多发性CMB的患者的CSF特征没有显著差异。我们的研究为AD和CAA-I中这些不同的MRI表现背后的不同病理生理机制提供了证据。

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