阿尔茨海默病患者脑组织病理形态学及β-淀粉样蛋白免疫组织化学观察  

Pathomorphological and amyloid β protein immunohistochemical findings in autopsied brains of Alzheimer′s disease

作　　者：刘冬戈[1] 吴浩强[2] 满开泉[1] 罗锡源[2] 杨丽[1] 孙肇武[1] 

机构地区：[1]北京医院病理科,100730 [2]香港中文大学医学院威尔斯亲王医院病理系

出　　处：《中华病理学杂志》1999年第6期405-408,共4页Chinese Journal of Pathology

摘　　要：目的　探讨中国人阿尔茨海默病（Ａｌｚｈｅｉｍｅｒ′ｓ ｄｉｓｅａｓｅ，ＡＤ） 的发病情况、神经病理学特征，比较银浸染色法和β淀粉样蛋白免疫组化染色法在ＡＤ 病理诊断中的意义。方法　北京医院病理科１９８２～１９９８ 年间共有４４５ 例６０ 岁以上老年人尸检，其中２９ 例符合Ｋｈａｃｈａｔｕｒｉａｎ 和Ｍｉｒｒａ 的ＡＤ 病理诊断标准，占６．５％ 。参照Ｍｉｒｒａ 等的建议，对这２９ 例ＡＤ 患者脑组织于６ 个标准部位取材，行银浸染色（Ｂｏｄｉａｎ，Ｂｉｅｌｓｃｈｏｗｓｋｙ） 及β淀粉样蛋白免疫组化染色，并对老年斑及神经原纤维缠结进行计数分析。结果　老年斑有４ 种类型；β淀粉样蛋白免疫组化染色比银浸染色更敏感，能清晰地显示４ 型老年斑，而银浸染色仅能显示初级斑和神经突斑，显示小的弥漫斑和终末斑却不如免疫组化法；老年斑主要分布于海马、颞叶和额叶。神经原纤维缠结主要分布于海马、颞叶和杏仁核，其数量明显比老年斑少。本组２９ 例ＡＤ 中２５ 例有淀粉样变性脑血管病。结论　ＡＤ可能是中国人老年人痴呆的重要原因。蚁酸处理的β淀粉样蛋白免疫组化染色在ＡＤ的病理诊断中有重要作用。Objective To study the incidence and neuropathological features of Alzheimer′s disease in Chinese and the significance of silver and amyloid β protein staining for the pathological diagnosis of Alzheimer′s disease. Methods Among 445 autopsy cases above 60 years in age (including 60) collected from 1982 1998 in the Department of Pathology, Beijing Hospital, totally 29 cases were diagnosed as Alzheimer′s disease pathologically (6.5%), accompanying with a history of mental deterioration and the histological changes in certain areas of the brain fulfilling the Khachaturian or Mirra criteria. Tissue blocks were taken from 6 standard regions of the brains for Bodian, Bielschowsky and amyloid β protein immunostaining. Senile plaques and neurofibrillary tangles were quantified. Results Four main types of senile plaques were noticed and the result by amyloid β protein immunostaining was considered more sensitive than that of the silver impregnation staining. The former one enabled to demonstrate all the 4 types of senile plaques, while silver impregnation staining could only demonstrate clearly the primitive and neuritic plaques, but not the small diffuse and burn out plaques. The senile plaques were noticed to be focused in the hippocampus, superior temporal gyrus and middle frontal gyrus while the neurofibrillary tangles, were mainly obtained in the hippocampus, temporal cortex and amygdaloid. Cerebral amyloid angiopathy was found in 25 out of 29 Alzheimer′s disease cases. Conclusions Alzheimer′s disease may be the main cause of dementia among the elders in Chinese and immunostaining for amyloid β protein pretreated with formic acid may set a high value on the pathological diagnosis of Alzheimer′s disease.

关 键 词：病理学 痴呆 早老性痴呆 Β-淀粉样蛋白 

分 类 号：R749.160.2[医药卫生—神经病学与精神病学]