Sillus M, Saeger W, Linke R P, Müller D, Voigt C
Department of Pathology, Marienkrankenhaus, Hamburg, Germany.
Zentralbl Pathol. 1993 Aug;139(3):207-15.
For the assessment of the anatomical distribution of cerebral amyloid angiopathy (CAA) as well as that of amyloid plaques (AP), 955 post-mortem brain specimens from 653 patients (aged 14 to 95 years) were made available from a general hospital. Using histological and immunohistochemical techniques, we demonstrated amyloid angiopathy chiefly in the occipital, parietal and temporal regions. Senile plaques were mostly found in parietal, temporal and occipital areas. In our cases, neurofibrillary tangles were rarely prominent in the regions examined. There was often a significant difference in the frequency of amyloid angiopathy and of plaques in distinct areas between men and women. Congophilic angiopathy was associated with senile plaques in 82.3%, and neurofibrillary tangles with plaques in 76.9%. In comparison, the correlation of amyloid plaques with CAA (32.5%) and of plaques with neurofibrillary tangles (11.5%) was less pronounced. There was a strong association of cerebral vascular amyloid with age in both sexes, it was more pronounced in women than in men. Unexpectedly, CAA showed a decrease in frequency in men in the 7th and 8th decade of life. In addition, there was a positive correlation between the amount of CAA and spontaneous hemorrhages, but no correlation with ischemic encephalopathy. Immunohistochemistry showed that cerebral amyloid was neither amyloid of the AA- nor of the ATTR-(Antitransthyretin-, formerly anti-AF)-type. An antibody to the beta-protein (anti-A beta) showed cerebral vascular deposits to be congruent with the Congo red method, whereas senile plaques stained weakly and neurofibrillary tangles could not be stained at all with these antibodies.
为评估脑淀粉样血管病（CAA）以及淀粉样斑块（AP）的解剖分布，我们从一家综合医院获取了653例患者（年龄在14至95岁之间）的955份尸检脑标本。采用组织学和免疫组化技术，我们发现淀粉样血管病主要见于枕叶、顶叶和颞叶区域。老年斑大多出现在顶叶、颞叶和枕叶区域。在我们的病例中，在所检查的区域神经原纤维缠结很少显著。男女在不同区域淀粉样血管病和斑块的出现频率通常存在显著差异。嗜刚果红血管病与老年斑的关联率为82.3%，神经原纤维缠结与斑块的关联率为76.9%。相比之下，淀粉样斑块与CAA的相关性（32.5%）以及斑块与神经原纤维缠结的相关性（11.5%）则不那么明显。脑血管淀粉样物质在两性中均与年龄密切相关，在女性中比在男性中更为明显。出乎意料的是，CAA在70至80岁男性中的出现频率有所下降。此外，CAA的数量与自发性出血之间存在正相关，但与缺血性脑病无关。免疫组化显示，脑淀粉样物质既不是AA型也不是ATTR型（抗转甲状腺素蛋白型，原抗AF型）。β蛋白抗体（抗Aβ）显示脑血管沉积物与刚果红法一致，而老年斑染色较弱，这些抗体根本无法对神经原纤维缠结进行染色。
