阿尔茨海默病和血管性痴呆患者脑脊液中乙酰胆碱和胆碱检测及其临床意义  

The detection of cerebrospinal fluid acetylecholine and choline in patient with Alzheimer's disease and vascular dementia and their clinical significance

作　　者：贾建平[1] 贾健民[2] 周卫东[1] 徐敏[1] 楚长彪[1] 王海涛[1] 

机构地区：[1]首都医科大学宣武医院神经内科,北京100053 [2]邯郸市第一人民医院神经内科

出　　处：《中华神经科杂志》2002年第3期168-170,共3页Chinese Journal of Neurology

摘　　要：目的　探讨阿尔茨海默病 (AD)和血管性痴呆 (VD)患者脑脊液 (CSF)中乙酰胆碱 (ACh)和胆碱 (Ch)含量的异同以及它们与认知障碍的关系。方法　采用简易精神状态量表 (MMSE)对 2 2例AD、2 2例VD和 2 0名对照进行认知功能评分 ,利用高效液相色谱 电化学检测方法 (HPLC ECD)进行CSF的ACh和Ch检测 ,而后进行比较和分析。结果　AD组患者CSF的ACh含量 [(10 .7± 5 .1)nmol/L]低于对照组 [(34 .5± 9.0 )nmol/L](P =0 .0 0 1) ,与MMSE评分呈正相关。VD组患者CSF的ACh含量 [(16 .8± 7.4)nmol/L]也低于对照组 (P =0 .0 0 1) ,与MMSE评分呈正相关。AD组的CSF中Ch含量与对照组相比 [分别为 (6 2 7.6± 145 .1)nmol/L和 (716 .0± 15 9.4)nmol/L],差异无显著意义 ,与MMSE不呈相关关系。VD组患者CSF的Ch含量 [(887.4± 187.4)nmol/L]高于对照组 (P =0 .0 0 2 )和AD组患者 (P =0 .0 0 1)。结论　 (1)ACh的降低与认知障碍呈正相关 ,提示ACh是与记忆有关的重要神经递质 ;(2 )VD的ACh降低提示有与AD类似的发病机制 ;(3)AD患者ACh显著降低和VD患者胆碱显著增高有助于两者之间的鉴别 ;(4 )应用胆碱酯酶抑制剂来提高脑内ACh水平 ,不仅适用于AD ,也适用于VD。Objective To compare cerebralspinal fluid acetylcholine (ACh) and choline (Ch) in patients with Alzheimer's disease (AD) and vascular dementia (VD), and their correlation with cognitive impairment.Methods First, dementia scales of 22 ADs, 22 VDs and 20 controls were scored using MMSE. Then the concentrations of CSF ACh and Ch in AD and VD were examined using the high-performance liquid chromatography with electrochemical detector (HPLC-ECD). Finally, the scores of MMSE and concentrations of ACh and Ch were compared. Results The ACh concentrations in AD[(10.7±5.1)nmol/L] and VD [(16.8±7.4)nmol/L] were found to be significantly lower than in controls [(34.5±9.0)nmol/L]( P =0.001), and showed a significant positive correlation with MMSE scores. The Ch concentration in AD CSF [(627.6±145.1)nmol/L] was approximately the same as in controls [(716.0±159.4)nmol/L], and showed no correlation with MMSE scores. The Ch concentration in VD CSF [(887.4±187.4)nmol/L] was significantly higher than in AD ( P =0.001) and controls ( P =0.002).Conclusion (1)The depression of ACh is correlated with cognitive impairment, suggesting ACh is an important neurotransmitters for memory. (2) VD may have a similar pathogenesis as AD. (3) The depression of AD ACh concentration and elevation of VD Ch concentration in CSF may be a role in their differentiation. (4) The application of acetylcholinesterase inhibitors is suitable for AD and VD.

关 键 词：阿尔茨海默病 血管性痴呆 乙酰胆碱 胆碱 脑脊髓液 

分 类 号：R749.102[医药卫生—神经病学与精神病学]