脑脊液检测在阿尔茨海默病领域的应用现状

Cerebrospinal fluid test in diagnosis of AD

目的调查脑脊液检测在阿尔茨海默病(AD)领域的应用现状及临床医师的认知。方法109位临床医师中,初筛有腰椎穿刺(LP)临床操作经验和AD诊疗经验的医师100位,进行面对面定式访谈。结果43.0%的医师对于LP极有经验(>100位),73.0%的医师1次穿刺就可以成功。49.0%的医师认为LP几乎没有不适;88.0%的医师认为LP不适感低或与骨髓穿刺相比相似,93.0%的医师认为LP术后并发症发生率低或与骨髓穿刺相似。51.0%的医师认为LP对于AD研究有价值送检脑脊液常规和生化的医师比例为98.0%,送检感染检查(脑脊液涂片、细菌培养、药敏试验等)的为96.0%,送检β淀粉样蛋白(Aβ)、tau蛋白的均为33.0%,送检抗体、肿瘤脱落细胞、视神经脊髓炎的均为3.0%。结论LP在AD领域应用具有可行性并可以增加,临床医师对脑脊液tau蛋白及Aβ42的诊断价值和研究价值的认知存在不足,与权威指南/共识的推荐存在差距。因此有必要进一步加强对LP在AD诊断中应用的重视,推动国内AD领域的发展。

Objective To investigate the cerebrospinal fluid test in diagnosis of AD and its understanding in domestic clinicians.Methods Of the 109 clinicians,100 with experience in lumbar puncture(LP)and in diagnosis and treatment of AD underwent a face-face interview.Results Of the 100 clinicians,43.0%were experienced in LP for>100 cases,73%could successfully puncture the lumbar on the first try,49.0%believed that LP had almost no discomfort,88%believed that the discomfort of LP was low or similar to that of bone marrow puncture,93%believed that the incidence of complications after LP was low or similar to that of bone marrow puncture,51.0%believed that LP had a value in study of AD since 98.0%would send cerebrospinal fluid for routine examination and biochemical test,96.0%would send cerebrospinal fluid for infection detection(smear examination,bacterial culture and drug sensitivity test),33.0%would send cerebrospinal fluid for measuring serum Aβand tau protein levels,and 3.0%would send cerebrospinal fluid for detecting antibodies,exfoliated tumor cells and ophthalmoneuromyelitis.Conclusion LP can be used in diagnosis of AD.Clinicians have not fully understood the diagnostic and research value of tau protein and Aβ42 in cerebrospinal fluid,which is inconsistent with the recommendations in authoritative guidelines/consensus.It is thus necessary to attach importance to LP in diagnosis of AD in order to promote its development in our country.