老年人脑淀粉样血管病的临床及病理研究

目的 研究国内老年人脑淀粉样血管病的发病情况及其临床病理特点。方法 对362例尸检老年脑标本行β类淀粉多肽免疫组织化学染色及刚果红、Bodian、Luxol fast blue染色。结果 老年脑标本中脑淀粉样血管病的发生率为31．7％，且随年龄增加；额叶最常受累，其次为枕叶、顶叶；皮层下白质及小脑齿状核亦受累；脑淀粉样血管病与脑出血、多发性脑梗死及阿尔茨海默病关系密切；脑淀粉样血管病本身可导致痴呆。结论 脑淀粉样血管病在国内老年人中的发生率与国外报道相仿，但脑中分布范围较广；脑淀粉样血管病可能参与老年人脑血管病及不同类型痴呆的发病机制。

Prevalence and characteristics of cerebral amyloid angiopathy in the elderly

OBJECTIVE: To study the prevalence and clinico-neuropathological characteristics of Cerebral amyloid angiopathy (CAA) in Chinese elderly. METHODS: We examined 362 archived brains of aged Chinese from 60 to 95 years of age using an antibody against beta-amyloid peptide and with Gongo red, Bodian and Luxol fast blue stains. RESULTS: CAA appeared in 114 examined brains and the incidence rate in age groups of 60 - 69, 70 - 79, 80 - 89 and beyond 90 years was 22.1%, 26.7%, 46.5% and 66.7% separately; frontal lobe was the most frequently CAA involved part of brain; CAA may also distribute in subcortical white matter and cerebellum dentatus nucleus; close relationships were found between CAA and multiple cerebrovascular lesions, consequent dementia and Alzheimer disease; without other neuropathological changes, CAA alone may result in dementia. CONCLUSIONS: CAA is a common neuropathological finding in brains of Chinese elderly, with an increased prevalence with age. CAA may distribute in subcortical white matter and cerebellum dentatus nucleus, which have been seldom reported before and may contribute to vascular lesions in these areas. CAA may not only participate in the pathogenesis mechanisms of Alzheimer's disease and vascular dementia, but also result in dementia directly through cerebral hypoperfusion and chronic neuronal ischemia.