脑淀粉样血管病相关炎症1例并文献复习

doi:10.3760/cma.j.issn.1007-1245.2023.20.023

摘要/Abstract

摘要：

脑淀粉样血管病相关炎症（cerebral amyloid angiopathy-related inflammation，CAA-RI）是一种由β淀粉样蛋白（amyloid β，Aβ）沉积于中枢神经系统血管壁及血管周围而引起的炎性反应，从而引起一系列相关症状。本文报道威海市中心医院收治的1例老年女性患者，以认知障碍为首发症状，此次因急性脑叶出血入院。颅脑MRI提示多发T2及FLAIR脑叶皮质下白质及深部脑组织非对称性分布的高信号，伴左侧颞叶低信号（考虑新发出血），磁敏感加权成像（susceptibility-weighted imaging，SWI）提示颅内多发皮质/皮质下散在微出血以及皮质表面铁沉积，基因检测为ApoEε3/ε4，脑脊液微量总蛋白1 097 mg/L，Aβ42水平下降，tau蛋白升高，经过大剂量激素冲击治疗后症状较前改善。目前，对CAA-RI的认识不足，国内外相关病例报道较少。本文通过对此病例的分析及相关文献的复习，提高临床医生对本病的认识，及早诊断及治疗，从而改善患者预后。

关键词:

脑淀粉样血管病相关性炎症, β淀粉样蛋白, 载脂蛋白E, 磁共振成像

Abstract:

Cerebral amyloid angiopathy-related inflammation (CAA-RI) is an inflammatory reaction caused by the deposition of β amyloid protein (amyloid β, Aβ) in the vascular wall and peripheral vessels of the central nervous system, resulting in a series of related symptoms. We report an elderly female patient with cognitive impairment as the first symptom who was admitted to Weihai Central Hospital due to acute lobular hemorrhage. Craniocranial MRI showed multiple T2 and FLAIR hypersignals with asymmetric distribution of subcortical white matter and deep brain tissue, accompanied by low signal in the left temporal lobe (considering new blood). Susceptibility-weighted imaging (SWI) indicated multiple cortical/subcortical scattered microbleeds and cortical surface iron deposits; the gene detection indicated ApoE epsilon 3/epsilon 4; the cerebrospinal fluid trace total protein level was 1 097 mg/L; the Aβ42 level decreased; the tau protein level increased; the symptoms improved after the high-dose hormone shock therapy. At present, the understanding of CAA-RI is insufficient. There are few reports of related cases at home and abroad. Through the analysis of this case and the review of relevant literatures, this paper aims to improve clinicians' understanding on this disease, to make early diagnosis and treatment, and to improve the patients' prognosis.

Key words:

Cerebral amyloid angiopathy-related inflammation, β starch protein, Lipoprotein E, Magnetic resonance imaging

陈彩霞许桢源丛艳彬吴喜娟.

脑淀粉样血管病相关炎症1例并文献复习 [J]. 国际医药卫生导报, 2023, 29(20): 2933-2936.

Chen Caixia, Xu Zhenyuan, Cong Yanbin, Wu Xijuan.

One case of cerebral amyloid angiopathy-related inflammation and literature analysis [J]. International Medicine and Health Guidance News, 2023, 29(20): 2933-2936.

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