摘要
目的:了解具有特征性神经病理和神经化学改变,多病机异质性疾病老年痴呆的发病机制和现有的治疗药物,展望其先进治疗前景。资料来源:应用计算机检索PubMed数据库1995-06/2004-06与老年痴呆发病机制,治疗药物相关文章,检索词“AD,mechanisms,therapy”,限定文章语言种类为English。同时计算机检索万方数据库2002-01/2004-08的与老年痴呆相关文献,检索词“老年痴呆发病机制,治疗药物”,并限定文献语种为中文。资料选择:对资料进行初审,纳入标准:实验研究类文章。排除标准:综述类文献。对检索出的文献查找全文,筛除不相关的文献和重复的文献,保留近期和发表在权威杂志的文献。资料提炼:共收集32篇,符合纳入标准17篇,其中11篇关于老年痴呆的发病机制,4篇关于老年痴呆的治疗药物、余下2篇与两者均有关系。排除的15篇,为重复研究和综述类文章。资料综合:老年痴呆症是一种多病机异质性疾病,具有特征性神经病理和神经化学改变,常渐起病,起病可在老年前期,但老年期的发病率更高。老年痴呆症较为认可的4类发病机制:微管相关蛋白tau异常学说、Aβ毒性学说、载脂蛋白基因多态性学说和早老素基因突变学说,对老年痴呆症相关基因及其与细胞凋亡的关系研究及老年斑主要成分的Aβ毒性学说近年来研究较多。临床可分为6类治疗药物方法:胆碱能类药,干扰Aβ形成和沉积的药物,雌激素类药物,促进脑代谢药物,基因治疗,中医药治疗。抓住老年痴呆症患者神经纤维缠结和早老素形成的中心环节,不断调整和设计老年痴呆症早期诊断和治疗的策略,有可能推进老年痴呆症的研究进展。结论:老年痴呆症的研究,无论从病因病机及治疗药物、动物模型等方面,都取得了一定进展。但其防治仍是一个非常复杂的疑难问题,目前临床上较难治愈,国内外的研究均处在探索积累阶段。从基因及其与细胞凋亡的关系思考,以Aβ为突破口,阻止Aβ肽的聚集,抑制其形成低聚物,可能寻找到有效方法和研制有效药物的途径,对老年痴呆发病机制的研究深入,有助于老年痴呆症药物的研制。
OBJECTIVE： To investigate the characteristic neuropathological and neurochemical changes, know the pathogenesis and existent drugs for Alzheimer disease, which is a disorder caused by many factors, and look ahead of its advanced therapeutic prospect. DATA SOURCES： . A computer-based online search of Pubmed database was undertaken to identify the articles about the pathogenesis and drug therapy of Alzheimer disease puhlished in English from July 1995 to July 2004 by using the keywords of ＂Alzheimer disease, mechanisms, therapy＂. Meanwhile, Chinese articles about Alzheimer disease were searched in Wanfang database published between January 2002 and August 2004, the keywords were ＂Alzheimer disease, mechanisms, therapy＂. STUDY SELECTION： All articles were seleeted firstly. Inclusive criteria： experimental study. Inclusive criteria： review. The full-texts of the retrieved articles were searched, and the irrelative and duplicated articles were excluded. Articles published on authoritative magazines or recently were selected. DATA EXTRACTION： A total of 32 articles were collected, 17 of them accorded with the inclusive criteria,including 11 about the pathogenesis of Alzheimer disease, 4 about the drug therapy of Alzheimer disease, and 2 about both of them. The 15 excluded articles were duplicated studies and reviews. DATA SYNTHESIS： Alzheimer disease is a neurodegenerative disorder caused by many factors associated with neuropathological and neurochemical disorders, which is characterized by gradual onset and advanced age. Abnormity of tau protein, beta-amyloid, APOE genotype and presenilin-2 are the main mechanisms of Alzheimer disease Recent research is focused on the relation between genes related to Alzheimer disease and cell apoptosis, and the amyloid beta which consists of age pigment. The therapeutic drugs for AD in clinic are classified into 6 categories, that are acetylcholinesterase inhibitors, drug for disturbing form and accumulation of Aβ, estrogen, drug for promoting brain metabolism, gene and traditional Chinese medicine. Focused on the tangle of nerve fiber and presenilin-2 in the patients with Alzheimer disease, adjusted and planed the early diagnosis and therapeutical strategy of Alzheimer disease, The research on Alzheimer disease could be improved. CONCLUSION： Progress on etiology, therapeutical drugs and animal model of Alzheimer disease were made in recent years. But cures for Alzheimer disease is remain a very difficult problem and efforts to find a cure for Alzheimer disease after-the-fact have so far been disappointing. Research on Alzheimer disease at home or overseas is all at the early stage. From the relationship between gene and cell apoptosis, and prevention the accumula- tion of Aβ, effective methods and drugs for Alzheimer disease could be found. Deeply investigated on mechanism of Alzheimer disease also could contribute to developing new therapeutic drugs.
出处
《中国临床康复》
CSCD
北大核心
2005年第36期82-83,共2页
Chinese Journal of Clinical Rehabilitation
