伴有脑微出血的阿尔茨海默病患者的临床及影像学特点分析

目的 总结伴有脑微出血（CMBs）的阿尔茨海默病（AD）患者临床及影像学特点，探讨其可能的发病机制。方法 选取34例AD患者，分为CMBs阳性（CMBs+AD）组24及CMBs阴性（CMBs-AD组）10例，45例同期门诊就诊的非AD患者作为对照组，全部受试对象完善颅脑磁共振（MRI）检查及血生化、甲状腺相关激素（TSH、FT3、FT4、TPOAB、TGAB）检查。比较3组患者间化验结果及影像学特点，并分析对CMBs+AD组患者认知功能障碍与临床及影像学评分的相关性。结果 两个AD组的促甲状腺激素（TSH）、游离三碘甲状腺原氨酸（FT3）较对照组明显减少（P=0.043，0.041），差异有统计学意义。但两个AD组间比较无明显差异（P>0.05）。两个AD组的颞叶内侧萎缩（MTA）评分及皮质视觉等级（CAS）评分与对照比较均明显增加（P均<0.05），但两个AD组间比较无明显差异（P>0.05）。脑白质疏松（LA）的评分在3组间比较均无明显统计学差异。应用Pearson分析CMBs+AD患者各指标与认知功能损害相关性显示：MMSE总分、定向力、计算力及注意力与CMBs个数呈负相关，与TSH、FT3呈正相关；记忆力与MTA评分（总分、左侧）、CAS评分（总分及顶叶）呈负相关，与FT3呈正相关。结论 在CMBs+AD患者中，甲状腺激素（TSH、FT3）减少，主要影响MMSE总分、定向力、计算力及注意力的评分。MTA评分及CAS评分增加，主要影响患者的短时记忆功能，而CMBs的个数越多，认知损害程度越重。关于CMBs+AD患者的病因，推测可能是脑微出血使血管周围沉积的β-淀粉样蛋白增多，甲状腺激素影响Tau蛋白的磷酸化，二者使AD进展加速。

Clinical and imaging characteristics of Alzheimer's disease with cerebral microbleeding

Objective To summarize the clinical and imaging characteristics of Alzheimer''s disease (AD) patients with cerebral microbleeding (CMBs), and to explore its possible pathogenesis. Methods Totally 34 patients with AD were divided into CMBs positive group (24 cases) and CMBS negative group (10 cases); and 45 non-AD patients in the same period were taken as control group. All subjects were examined by craniocerebral magnetic resonance imaging (MRI) and blood biochemistry, thyroid-related hormones (TSH, FT3, FT4, TPOAB, TGAB). The results of laboratory tests and imaging characteristics were compared among the three groups, and the correlation between cognitive impairment and clinical and imaging scores in CMBs+AD group was analyzed. Results Thyrotropin (TSH) and free triiodothyronine (FT3) in the two AD groups were significantly lower than those in the control group (P=0.043, 0.041). However, there was no significant difference between the two AD groups (P>0.05). Compared with the control group, the MTA scores and CAS scores of the two AD groups increased significantly (P<0.05), but there was no significant difference between the two AD groups (P>0.05). There was no significant difference among the three groups on LA scores (P>0.05). Pearson was used to analyze the correlation between cognitive impairment and each index of CMBs+AD patients:MMSE total score, orientation, calculation and attention were negatively correlated with the number of CMBs, positively correlated with TSH and FT3; memory was negatively correlated with MTA score (total score, left side), CAS score (total score and parietal lobe), and positively correlated with FT3. Conclusion Thyroid hormones (TSH, FT3) decrease in patients with CMBs+AD and are positively correlated with cognitive impairment. The increase of MTA and CAS scores mainly affects the short-term memory function of patients. The more CMBs are, the more severe the cognitive impairment is. To speculate the etiology of CMBs+AD patients, cerebral microbleeding may increase the deposition of beta-amyloid protein around blood vessels, and thyroid hormone may affect the phosphorylation of Tau protein, both of which accelerate the progress of AD.