早发型与晚发型阿尔茨海默病临床特征及影像学生物标志物比较  

The Comparison of Clinical Characteristics and Biomarker Profiles in Early and Late-onset Alzheimer's Disease

作　　者：吴婕 王洁 马小茜 肖朕旭 周孝文 梁小妞 郑琍 丁玎 赵倩华 WU Jie;WANG Jie;MA Xiao-xi;XIAO Zhen-xu;ZHOU Xiao-wen;LIANG Xiao-niu;ZHENG Li;DING Ding;ZHAO Qian-hua(Department of Neurology,Huashan Hospital,Fudan University,Shanghai 200040,China;Institute of Neurology,Huashan Hospital,Fudan University,Shanghai 200040,China;National Clinical Research Center for Aging and Medicine,Huashan Hospital,Fudan University,Shanghai 200040,China;MOE Frontiers Center for Brain Science,Fudan University,Shanghai 200040,China)

机构地区：[1]复旦大学附属华山医院神经内科,上海200040 [2]复旦大学附属华山医院神经病学研究所,上海200040 [3]国家老年疾病临床医学研究中心,上海200040 [4]复旦大学脑科学前沿中心,上海200040

出　　处：《中国临床神经科学》2025年第1期29-37,64,共10页Chinese Journal of Clinical Neurosciences

基　　金：国家自然科学基金项目(编号:82071200,82371429)。

摘　　要：目的 探究早发型阿尔茨海默病(EOAD)和晚发型阿尔茨海默病(LOAD)的临床特征与生物标志物差异。方法从上海记忆队列人群中选择47例EOAD患者(EOAD组)和65例LOAD患者(LOAD组),所有患者接受β淀粉样蛋白正电子发射断层显像(Aβ-PET)扫描,78例患者接受tau-PET扫描。所有患者接受认知功能评估随访。横断面比较基线临床特征及影像学生物标志物特征;混合线性效应模型进行纵向认知损害变化的组间比较;多因素线性回归模型探究MMSE量表评分年变化值的影响因素。结果 与LOAD组比较,EOAD组ApoE ε4携带率更低;视空间功能更差;全脑Aβ标准摄取值比值(SUVR)以及BraakⅠ、Ⅲ-Ⅳ以及Ⅴ-Ⅵ阶段的受累脑区tau SUVR更高(均P<0.05)。起病年龄更早的患者MMSE量表评分下降速度更快,MMSE量表评分年下降值与基线tauSUVR呈正相关(均P<0.05),未观察到全脑Aβ SUVR与MMSE量表评分年下降值的关联。结论 EOAD患者具有更重的非遗忘性认知损害、更重的Aβ和tau病理负荷以及更快的认知损害下降速率。Aim To investigate the differences in clinical characteristics and biomarkers profiles between early-onset Alzheimer's disease(EOAD)and late-onset Alzheimer's disease(LOAD).Methods Forty-seven EOAD and 65 LOAD patients were recruited from the Shanghai Memory Cohort Study.All patients underwentβ-amyloid positron emmisson tomography(Aβ-PET)scans,and 78 received tau PET scans.All patients underwent cognition follow-ups.Cross-sectional comparisons of clinical characteristics and PET imaging biomarkers were performed between the two groups.A mixed linear effects model was utilized for the comparisons of longitudinal cognitive changes between the groups,and a multiple linear regression model was employed to explore the influencing factors of the annual change in Mini-Mental State Examination(MMSE)scores.Results Compared to the LOAD group,the EOAD group exhibited a lower ApoEε4 frequency,more severe impairment in visuospatial function,higher whole-brain Aβstandradized uptake value ratio(SUVR),and elevated tau SUVR in the Braak stagesⅠ,Ⅲ-Ⅳ,andⅤ-Ⅵbrain regions(P<0.05 for all).Patients with an earlier onset age demonstrated a faster decline in MMSE scores.Additionally,a positive correlation was observed between the baseline tau SUVR in Braak stages I,Ⅲ-Ⅳ,andⅤ-Ⅵand the annual decline in MMSE scores(P<0.05 for all),while no significant association was found between the whole-brain AβSUVR and annual MMSE score decline.Conclusion Patients with EOAD exhibit more severe non-amnestic cognitive impairment,greater Aβand tau pathological burden,and a faster rate of cognitive decline compared to those with LOAD.

关 键 词：阿尔茨海默病 早发型 晚发型 正电子发射断层显像 Β淀粉样蛋白 TAU蛋白 

分 类 号：R749.1[医药卫生—神经病学与精神病学]