Понимание причин и лечению болезни

Почему же до самого последнего времени такое тяжкое заболевание не привлекало серьезного внимания врачей, и мы даже не представляли, как широко оно распространено? Для ученых-медиков болезнь — это общая картина патологии, весь комплекс изменений (обычно прогрессирующих) в функционировании и внешнем виде организма пациента, в микроструктуре пораженных органов и тканей и в характере их роста. Еще в 1907 г. немецкий невропатолог Алоис Альцгеймер описал называемую теперь его именем болезнь, поражающую некоторых людей сорока- и пятидесятилетнего возраста, с ее специфическим сочетанием клинических и патологических признаков.

Довольно долго это заболевание считалось особой формой пресенильного (предстарческого) слабоумия; о пожилых людях с подобными симптомами говорилось, что они страдают от «одряхления» или «отвердения артерий». За последние годы поданным аутопсий стало ясно, что в мозгу у большинства пожилых людей со слабоумием имеются все характерные признаки болезни Альцгеймера, причем их выраженность коррелирует со степенью ухудшения умственных способностей. Как теперь установлено, болезнью Альцгеймера поражены 1,5—2 млн. американцев, и из них умирают от нее по крайней мерс 100 тыс. человек в год. Тем не менее до сих пор никто не знает, как возникает заболевание, в чем причина связанных с ним характерных изменений и как его лечить.

Как же перейти от описания болезни

к пониманию ее причин и лечению? Один из путей достижения этой цели — разработка концептуальных моделей, основанных на наблюдаемых симптомах и патологических изменениях и учитывающих процессы, которые могут их вызвать. Каждая модель затем проверяется и либо отбрасывается, либо совершенствуется до тех пор, пока не будет доказана ее истинность, лучший критерий которой — предсказание эффективного способа лечения. В настоящее время большинство исследователей принимают во внимание шесть моделей болезни Альцгеймера, основанных на шести гипотезах, объясняющих гибель нейронов.

Одна из гипотез опирается на тот факт, что в мозгу людей, страдающих болезнью Альцгеймера, резко сокращается запас важнейшего медиатора — ацетилхолина; предполагается, что гибнут те нейроны, отростки которых выделяют ацетилхолин. Другие гипотезы носят более общий характер: гибель нейронов объясняется генетическими дефектами, аномальными скоплениями белков, воздействием инфекционных агентов или токсинов, попадающих в организм извне, нарушениями кровообращения и обмена энергии. Каждая гипотеза одними наблюдениями и экспериментами поддерживается, а другими опровергается. Я рассмотрю все модели, оставив напоследок ацетилхолиновую, которая привлекает наибольший интерес и служит основанием для большинства попыток найти способ лечения болезни Альцгеймера.

 

 

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