脑脊液生物标志物对尸检证实队列中痴呆症鉴别诊断的附加诊断价值。
Added Diagnostic Value of Cerebrospinal Fluid Biomarkers for Differential Dementia Diagnosis in an Autopsy-Confirmed Cohort.
机构信息
Reference Center for Biological Markers of Dementia (BIODEM), Laboratory of Neurochemistry and Behavior, and Biobank, Institute Born-Bunge, University of Antwerp, Antwerp, Belgium.
Current affiliation: Department of Neurosurgery, University Hospital Antwerp, Edegem, Belgium.
出版信息
J Alzheimers Dis. 2018;63(1):373-381. doi: 10.3233/JAD-170927.
BACKGROUND
Differential dementia diagnosis remains a challenge due to overlap of clinical profiles, which often results in diagnostic doubt.
OBJECTIVE
Determine the added diagnostic value of cerebrospinal fluid (CSF) biomarkers for differential dementia diagnosis as compared to autopsy-confirmed diagnosis.
METHODS
Seventy-one dementia patients with autopsy-confirmed diagnoses were included in this study. All neuropathological diagnoses were established according to standard neuropathological criteria and consisted of Alzheimer's disease (AD) or other dementias (NONAD). CSF levels of Aβ1 - 42, T-tau, and P-tau181 were determined and interpreted based on the IWG-2 and NIA-AA criteria, separately. A panel of three neurologists experienced with dementia made clinical consensus dementia diagnoses. Clinical and CSF biomarker diagnoses were compared to the autopsy-confirmed diagnoses.
RESULTS
Forty-two patients (59%) had autopsy-confirmed AD, whereas 29 patients (41%) had autopsy-confirmed NONAD. Of the 24 patients with an ambiguous clinical dementia diagnosis, a correct diagnosis would have been established in 67% of the cases applying CSF biomarkers in the context of the IWG-2 or the NIA-AA criteria respectively.
CONCLUSION
AD CSF biomarkers have an added diagnostic value in differential dementia diagnosis and can help establishing a correct dementia diagnosis in case of ambiguous clinical dementia diagnoses.
背景
由于临床特征重叠，鉴别痴呆诊断仍然具有挑战性，这往往导致诊断上的疑问。
目的
与尸检证实的诊断相比，确定脑脊液（CSF）生物标志物在鉴别痴呆诊断中的附加诊断价值。
方法
本研究纳入了 71 例经尸检证实的痴呆患者。所有神经病理学诊断均根据标准神经病理学标准确定，包括阿尔茨海默病（AD）或其他痴呆（NONAD）。根据 IWG-2 和 NIA-AA 标准，分别测定并解释 CSF 中 Aβ1-42、T-tau 和 P-tau181 的水平。一组三位具有痴呆经验的神经科医生做出了临床共识痴呆诊断。将临床和 CSF 生物标志物诊断与尸检证实的诊断进行比较。
结果
42 例患者（59%）经尸检证实为 AD，29 例患者（41%）经尸检证实为 NONAD。在 24 例临床痴呆诊断不明确的患者中，如果分别应用 IWG-2 或 NIA-AA 标准中的 CSF 生物标志物，有 67%的病例可以明确诊断。
结论
AD CSF 生物标志物在鉴别痴呆诊断中有附加的诊断价值，并有助于在临床痴呆诊断不明确的情况下建立正确的痴呆诊断。
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