Alzheimer病的病理与临床诊断

The pathological and clinical diagnosis of Alzheimer disease

对生前经过痴呆调查与临床诊断的９例老人院住院老人死亡后进行尸解与神经病理学观察。结果发现９例尸检脑均有不同程度的萎缩与锥体细胞减少，脂褐素沉积，胶质细胞增生，淀粉样小体存在。其中３例尚在皮层与海马中发现大量老年斑（ＳＰｓ）与神经原纤维缠结（ＮＦＴｓ），病理确诊为Ａｌｚｈｅｉｍｅｒ病（ＡＤ）；其余６例明确为非Ａｌｚｈｅｉｍｅｒ病老年脑（ＮＡＤ）。该病理结果与临床诊断全部符合，提示ＮＩＮＣＤＳ－ＡＤＲＤＡ之ＡＤ临床诊断标准的可靠性及实用性。作者强调反复临床检查与随访能显著提高ＡＤ临床诊断的准确性与可靠性。

Nine autopsies on individuals including 3 patients with Alzheimer disease(AD) and 6 aged controls were performed. The clinical diagnosis of AD was used by the NINCDS ADRDA criteria, and the results showed that there were, to some extents, brain atrophy and pyramidal cells reduction, gliacytes hyperplasia lipoidosis and corpora amylacca deposition in all 9 brains. Furtherly in 3 brains of patients with AD, we found many senile plaques (SPs),neurofibrillary tangles (NFTs) in cerebral cortexes and hippocampues. According to Khachaturian's criteria of neuropathology diagnosis for AD, these 3 cases were definitely diagnosed as 'AD', the others was pathologically diagnosed as non AD (NAD). Therefore, the pathological results were consistent with clinical diagnosis of AD by NINCDS ADRDA criteria in our research, which suggested this criteria was practical and reliable in China. Simultaneously, we thought that repeated clinical examinations and following up observations could significantly improve accuracy and reliability of clinical diagnosis of AD.