[1]7000 洛阳,河南科技大学第一附属医院神经内科[张维雄 曹妍妍 杜敢琴(通信作者)].脑淀粉样血管病相关炎症3例临床分析并文献复习[J].卒中与神经疾病杂志,2023,30(04):395-401.[doi:10.3969/j.issn.1007-0478.2023.04.014]
点击复制

脑淀粉样血管病相关炎症3例临床分析并文献复习()
分享到:

《卒中与神经疾病》杂志[ISSN:1007-0478/CN:42-1402/R]

卷:
第30卷
期数:
2023年04期
页码:
395-401
栏目:
论著
出版日期:
2023-08-20

文章信息/Info

文章编号:
1007-0478(2023)04-0395-07
作者:
471000 洛阳河南科技大学第一附属医院神经内科[张维雄 曹妍妍 杜敢琴(通信作者)]
张维雄 曹妍妍 杜敢琴
关键词:
脑淀粉样血管病相关炎症 脑微出血 磁共振成像 免疫治疗
分类号:
R743
DOI:
10.3969/j.issn.1007-0478.2023.04.014
文献标志码:
A
摘要:
目的 探讨脑淀粉样血管病相关炎症(Cerebral amyloid angiopathy-related inflammation,CAA-RI)患者的临床表现,血清、脑脊液检查,影像学特征以及治疗。方法 收集3例临床诊断为CAA-RI患者的临床资料,对其临床表现,血清、脑脊液检查,影像学特征及治疗进行回顾性分析并复习相关文献。结果 2例患者主要临床表现为精神异常、认知功能下降,1例患者仅表现为头晕、失眠。3例患者中2例脑脊液白细胞数轻度升高、1例正常,3例蛋白水平均升高,2例脑脊液淀粉样蛋白β(β-amyloid,Aβ)42水平降低; 2例行血载脂蛋白E(Apolipoprotein E,APoE)基因检测显示1例为3/3,另1例为4/4。3例患者颅脑磁共振(Magnetic resonance imaging,MRI)均表现为非对称性多发脑白质病变,磁敏感加权序列(Susceptibility-weighted imaging,SWI)表现为多个脑叶弥漫分布的微出血。经糖皮质激素治疗,3例患者临床症状均有改善。结论 CAA-RI常见临床表现为认知功能下降、精神异常、癫痫、头痛,也有少数患者表现为头晕等较轻症状; 多模式影像学检查、脑脊液Aβ及APoE基因筛查有助于CAA-RI的诊断; 临床诊断CAA-RI,应尽早给予免疫抑制剂治疗,改善临床症状; 相关文献研究提示该病预后不佳。

参考文献/References:

[1] Chung KK,Anderson NE,Hutchinson D,et al.Cerebral amyloid angiopathy related inflammation: three case reports and a review[J].J Neurol Neurosurg Psychiatry,2011,82(1):20-26.
[2] Auriel E,Charidimou A,Gurol ME,et al.Validation of clinicoradiological criteria for the diagnosis of cerebral amyloid angiopathy-related inflammation[J].JAMA Neurol,2016,73(2):197-202.
[3] Corovic A,Kelly S,Markus HS,et al.Cerebral amyloid angiopathy associated with inflammation:a systematic review of clinical and imaging features and outcome[J].Int J Stroke,2018,13(3):257-267.
[4] Antolini L,DiFrancesco JC,Zedde M,et al.Spontaneous ARIA-like events in cerebral amyloid angiopathy-related inflammation: a multicenter prospective longitudinal cohort study[J].Neurology,2021,97(18):e1809-e1822.
[5] Banerjee G,Alvares D,Bowen J,et al.Minimally symptomatic cerebral amyloid angiopathy-related inflammation: three descriptive case reports[J].J Neurol Neurosurg Psychiatry,2019,90(1):113-115.
[6] Nakaya M,Hashimoto H,Usui G,et al.Cerebral amyloid-β-related angiitis without cerebral microbleeds in a patient with subarachnoid hemorrhage[J].Cardiovascular Pathology,2019,42:36-40.
[7] 徐进,周仪,李春星,等.SWI联合DWI在早期诊断脑淀粉样血管病及其相关炎症中的价值[J].南通大学学报(医学版),2020,40(5):476-479.
[8] Salvarani C,Morris JM,Giannini C,et al.Imaging findings of cerebral amyloid angiopathy, Aβ-Related angiitis(ABRA), and cerebral amyloid angiopathy-related inflammation: a Single-Institution 25-Year experience[J].Medicine(Baltimore),2016,95(20):e3613.
[9] Chu SG,Xu FJ,Su Y,et al.Cerebral amyloid angiopathy(CAA)-related inflammation: comparison of inflammatory CAA and amyloid-β-related angiitis[J].J Alzheimers Dis,2016,51(2):525-532.
[10] Coulette S,Renard D,Lehmann S,et al.A Clinico-radiological study of cerebral amyloid angiopathy-related inflammation[J].Cerebrovasc Dis,2019,48(1/2):38-44.
[11] Piazza F,Greenberg SM,Savoiardo M,et al.Anti-amyloid β autoantibodies in cerebral amyloid angiopathy-related inflammation: implications for amyloid-modifying therapies[J].Ann Neurol,2013,73(4):449-458.
[12] Renard D,Wacongne AN,Ayrignac X,et al.Cerebrospinal fluid alzheimer's disease biomarkers in cerebral amyloid angiopathy-related inflammation[J].J Alzheimers Dis,2016,50(3):759-764.
[13] Grangeon L,Quesney G,Verdalle-Cazes M,et al.Different clinical outcomes between cerebral amyloid angiopathy-related inflammation and non-inflammatory form[J].J Neurol,2022,269(9):4972-4984.
[14] Graff-Radford J,Lesnick T,Rabinstein AA,et al.Cerebral microbleed incidence, relationship to amyloid burden: the Mayo clinic study of aging[J].Neurology,2020,94(2):e190-e199.
[15] Renard D,Collombier L,Demattei C,et al.Cerebrospinal fluid, MRI, and florbetaben-PET in cerebral amyloid angiopathy-related inflammation[J].J Alzheimers Dis,2018,61(3):1107-1117.
[16] Sakai KJ,Noguchi-Shinohara M,Ikeda T,et al.Cerebrospinal fluid cytokines and metalloproteinases in cerebral amyloid angiopathy-related inflammation[J].Acta Neurol Scand,2021,143(4):450-457.
[17] Charidimou A.Cerebral amyloid angiopathy-related inflammation biomarkers: where are we now?[J].J Alzheimers Dis,2016,50(1):9-11.
[18] Regenhardt RW,Thon JM,Das AS,et al.Association between immunosuppressive treatment and outcomes of cerebral amyloid angiopathy-related inflammation[J].JAMA Neurol,2020,77(10):1261-1269.
[19] Rempe T,Sollero CEV,Rodriguez E,et al.Corticosteroids Lead to short-term improvement in cerebral amyloid angiopathy-related inflammation[J].J Neuroimmunol,2020,348:577377.
[20] Plotzker AS,Henson RL,Fagan AM,et al.Clinical and paraclinical measures associated with outcome in cerebral amyloid angiopathy with related inflammation[J].J Alzheimers Dis,2021,80(1):133-142.

备注/Memo

备注/Memo:
基金项目:河南省医学科技攻关计划联合共建项目(LHGJ202110590)
更新日期/Last Update: 2023-08-20