Longitudinal Neuroimaging Analysis in Mild-Moderate Alzheimer's Disease Patients Treated with Plasma Exchange with 5% Human Albumin.
Longitudinal Neuroimaging Analysis in Mild-Moderate Alzheimer's Disease Patients Treated with Plasma Exchange with 5% Human Albumin.
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DOI：
10.3233/jad-170693
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发表时间：
2018
期刊：
影响因子：
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通讯作者：
Páez A
中科院分区：
文献类型：
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作者：
Cuberas-Borrós G;Roca I;Boada M;Tárraga L;Hernández I;Buendia M;Rubio L;Torres G;Bittini Á;Guzmán-de-Villoria JA;Pujadas F;Torres M;Núñez L;Castell J;Páez A
最近，在接受血浆置换（PE）和白蛋白替代治疗的轻度-中度阿尔茨海默病（AD）患者中，脑脊液和血浆中Aβ1-42水平的改变与记忆和语言功能的改善有关。作为II期临床试验的一部分，检测pe治疗的AD患者大脑结构和功能的变化。患者接受3 - 18例白蛋白（Albutein®5%,Grifols）或假PE（对照组）的PE治疗，为期21周（分为一个强化期和两个维持期），随访6个月。在第0周（基线）、第21周和第44周（在第9周和第33周进行额外的SPECT），使用自动化软件（NeuroGam®）通过SPECT扫描评估脑灌注和通过MRI评估脑结构变化。采用统计参数映射（基于体素的分析，SPM）和z分数计算来调查基线的变化。纳入42例患者（39例可评估；37例分析；18例pe治疗；19例对照组）。两组患者海马区和总颅内容积均有减小的趋势（p < 0.05）。6个月后，pe治疗患者额、颞、顶叶脑灌注损失较对照组减少，且pe治疗期间Brodmann区BA38-R灌注稳定（p < 0.05）。SPM分析显示，pe治疗患者的灌注损失稳定或无进展，直到第21周，在对照组中未观察到。轻中度AD患者表现为脑容量减少和脑灌注损伤，这与疾病进展的预期一致。白蛋白替代pe治疗有利于血流灌注的稳定。
Recently, modifications of Aβ1-42 levels in CSF and plasma associated with improvement in memory and language functions have been observed in patients with mild-moderate Alzheimer’s disease (AD) treated with plasma exchange (PE) with albumin replacement. To detect structural and functional brain changes in PE-treated AD patients as part of a Phase II clinical trial. Patients received between 3 and 18 PE with albumin (Albutein® 5%, Grifols) or sham-PE (controls) for 21 weeks (divided in one intensive and two maintenance periods) followed by 6-month follow-up. Brain perfusion assessed by SPECT scans using an automated software (NeuroGam®) and brain structural changes assessed by MRI were performed at weeks 0 (baseline), 21, and 44 (with additional SPECT at weeks 9 and 33). Statistical parametric mapping (voxel-based analysis, SPM) and Z-scores calculations were applied to investigate changes to baseline. 42 patients were recruited (39 evaluable; 37 analyzed: 18 PE-treated; 19 controls). There was a trend toward decreasing hippocampi and total intracranial volume for both patient groups during the study (p < 0.05). After six months, PE-treated patients had less cerebral perfusion loss than controls in frontal, temporal, and parietal areas, and perfusion stabilization in Brodmann area BA38-R during the PE-treatment period (p < 0.05). SPM analysis showed stabilization or absence of progression of perfusion loss in PE-treated patients until week 21, not observed in controls. Mild-moderate AD patients showed decreased brain volume and impairment of brain perfusion as expected for the progression of the disease. PE-treatment with albumin replacement favored the stabilization of perfusion.