知识与财富的链接
多病共存在阿尔茨海默病(Alzheimer's disease,AD)人群中较为常见,随着AD血浆标志物的进展,逐渐被临床使用。其中,共病负担的肾功能波动、慢性低度炎症、营养与体成分改变及多重用药暴露等,使血浆AD生物标志物出现变化,进而影响纵向趋势判读、随访分层稳定性及跨队列证据整合的可靠性。本文围绕共病背景下血浆AD生物标志物的阈值判读,系统回顾既往研究证据,归纳共病模式与β淀粉样蛋白42/40比值(amyloid-β42/40,Aβ42/40)、磷酸化tau蛋白(phosphorylated tau,p-tau)、神经丝轻链(neurofilament light chain,NfL)、胶质纤维酸性蛋白(glial fibrillary acidic protein,GFAP)等指标的关联特征及主要偏倚来源以及调控协变量方案,为多病共存背景下血浆标志物的规范化解读与临床应用提供参考。
Multimorbidity is relatively common among individuals with Alzheimer's disease (AD).With rapid advances in AD plasma biomarkers, they have gradually been adopted in clinical practice.Among them, the burden of comorbidity, such as fluctuating renal function, chronic low-grade inflammation, alterations in nutritional status and body composition, and exposure to polypharmacy, may collectively shift plasma AD biomarker profiles, thereby affecting the interpretation of longitudinal trends, the stability of follow-up risk stratification, and the reliability of cross-cohort evidence integration.This article systematically reviewed the existing evidence on the threshold-based interpretation of plasma AD biomarkers in the context of multimorbidity, summarizes the association patterns between comorbidity profiles and key plasma biomarkers such as the amyloid-β42/40 ratio (Aβ42/40), phosphorylated tau (p-tau), neurofilament light chain (NfL), and glial fibrillary acidic protein (GFAP), as well as major sources of bias and covariate adjustment strategies, aiming to provide a reference for the standardized interpretation and clinical implementation of plasma biomarkers in the context of multimorbidity.
