摘要
β-淀粉样蛋白(Aβ)是生物体中一种常见的蛋白,参与形成细菌生物膜、影响褪黑素产生等重要生理功能。与此同时,错误折叠或过多的Aβ也是一种潜在的致病因子,可以引发器官或系统的淀粉样变性。脑淀粉样血管病(CAA)作为脑小血管病中比较常见的一种,其特征就是Aβ1~40肽段的异常沉积,其不仅会破坏脑血管的正常结构,还会影响神经元的正常结构、功能,增加脑出血的风险。除此之外,Aβ还可以在CAA的病理基础上进一步诱发患者自身免疫反应,导致CAA相关炎症(CAA-ri)的多种病理改变。临床上阿尔茨海默病患者往往与CAA共存。近年来,针对阿尔茨海默病患者的靶向Aβ蛋白抗体治疗方法不断涌现,包括单克隆抗体治疗,少数患者会出现淀粉样蛋白相关影像学异常。这些疗法都在降低淀粉样蛋白水平、改善患者临床症状方面有显著效果,但其治疗效率和不良反应仍是目前研究面临的重大挑战。文中讨论了淀粉样蛋白在CAA、CAA-ri的临床早期中扮演的角色,为早期识别和早期干预提供决策。
Amyloid-β(Aβ)is a common protein in organisms.It participates in important physiological functions such as bacterial biofilms and affects melatonin production,and misfolded or excessive Aβis a potential pathogenic factor that can cause amyloidosis in organs or systems.Cerebral amyloid angiopathy(CAA),as a common cerebral small vessel disease,is characterized by abnormal deposition of 1-40 peptides of Aβprotein,which will not only damage the normal structure of cerebral vessels,but also affect the normal structure and function of neurons,increasing the risk of cerebral hemorrhage.In addition,Aβprotein can further induce autoimmune response on the basis of CAA pathology,leading to a variety of pathological changes of CAA related inflammation(CAA-ri).Clinically,Alzheimer′s disease patients often coexist with CAA.In recent years,targeted Aβprotein antibody therapy for Alzheimer′s disease patients has been emerging,including monoclonal antibody therapy.A few patients will have amyloid related imaging abnormalities.These therapies have significant effects in reducing amyloid levels and improving patients′clinical symptoms,but their treatment efficiency and side effects are still major challenges facing current research.The role of amyloid protein in the clinical early recognition of CAA and CAA-ri and the decision-making of early intervention were discussed in this article.
作者
李一凡
陆正齐
Li Yifan;Lu Zhengqi(Department of Neurology,the Third Affiliated Hospital of Sun Yat-sen University,Guangzhou 510630,China)
出处
《中华神经科杂志》
北大核心
2025年第8期811-815,共5页
Chinese Journal of Neurology
