Sporadic cerebral amyloid angiopathy is not a frequent cause of spontaneous brain hemorrhage
Sporadic cerebral amyloid angiopathy is not a frequent cause of spontaneous brain hemorrhage
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DOI：
10.1111/j.1468-1331.2007.01880.x
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发表时间：
2007-08-01
影响因子：
5.1
通讯作者：
Attems, J.
中科院分区：
文献类型：
--
作者：
Jellinger, K. A.;Lauda, F.;Attems, J.
对连续尸检的1100例老年人(平均年龄78.3±6.8岁)进行了回顾性研究，发现散发性脑淀粉样血管病(CAA)占50.0%，95.7%的尸检证实为阿尔茨海默病(AD)。载脂蛋白(APOE)epsilon 3/4和epsilon 4/4在AD患者中的频率明显高于对照组，且与CAA的严重程度相关。自发性(非创伤性)脑出血(不包括微量出血和出血性脑梗塞)发生率为5.4%，在AD患者中仅为3.3%。CAA在非脑出血患者中的发生率为50.6%，在脑出血患者中的发生率为42.4%，后者严重程度CAA的发生率显著高于对照组。ICH与CAA相关的占42.4%，而与CAA无关的占57.6%。CAA患者年龄较大，临床痴呆和经病理证实的AD的发生率较高，但40%的患者出现高血压体征(病史和/或尸检)，而非CAA相关ICH患者的这一比例为80%。CAA相关性脑出血多累及脑叶或大脑半球，而非CAA相关性脑出血多累及基底节和脑干。CAA在脑出血患者中的患病率低于无脑出血患者和脑出血合并CAA患者和不合并CAA患者，这一数据不支持CAA是老年人脑出血最重要的危险因素的概念，可能是因为其他危险因素包括高血压。
The retrospective study of a consecutive autopsy series of 1100 elderly subjects (mean age 78.3 +/- 6.8 SD years), revealed sporadic cerebral amyloid angiopathy (CAA) in 50.0% and in 95.7% of autopsy-confirmed cases of Alzheimer disease ( AD). Apolipoprotein (APOE) epsilon 3/4 and epsilon 4/4 were significantly more frequent in AD than in controls, and were associated with more severe degrees of CAA. Spontaneous (nontraumatic) intracerebral hemorrhages (ICH) (excluding microbleeds and hemorrhagic infarctions) were seen in 5.4% and only in 3.3% of AD cases. CAA was found in 50.6% of brains without and in 42.4% with ICH, the latter showing a significantly higher frequency of severe degrees of CAA. ICH was related to CAA in 42.4%, whilst no such relation was seen in 57.6%. Patients with CAA were older, showed a higher frequency of clinical dementia and pathologically confirmed AD, but signs of hypertension (history and/or autopsy) occurred in 40%, compared with 80% in those with non-CAA-related ICHs. CAA-related ICH more frequently involved in cerebral lobes or hemispheres, whilst non-CAA-related ones were more often located in the basal ganglia and brainstem. The data of a lower prevalence of CAA in cases with than without ICH and of ICH with and without CAA do not support the concept that CAA represents the most important risk factor for ICH in the aged, probably because of other risk factors including hypertension.