Ток крови

Есть некая ирония в том, что в настоящее время ток крови рассматривается как фактор развития болезни Альцгеймера. Еще не так давно слабоумие пожилых людей объясняли плохой циркуляцией крови или «отвердением артерий». Позднее стало ясно, что при болезни Альцгеймера имеют значение не атеросклеротические явления и микроинсульты, а недостаточность ацетил- холнна, нейрофибриллярные клубки, сенильные бляшки и амилоид в сосудах мозга. Теперь же заговорили о том, что это заболевание связано, по крайней мере частично, с заметным уменьшением количества поступающей в мозг крови, а также количества кислорода и глюкозы, извлекаемых клетками мозга из этой крови, и энергии, получаемой за счет окисления глюкозы. В основном таким представлением мы обязаны изучению метаболизма мозга новыми способами, исключающими внедрение в его ткани. Например, применяется метод позитронной томографии. Интересующее исследователей соединение после соответствующей обработки приобретает способность испускать позитроны. Если этот препарат ввести пациенту, то с помощью сканирующего регистрирующего устройства, данные с которого сразу анализируются на ЭВМ, можно проследить за его распределением в мозгу.

Р. Фраковяк и Дж. Гиббс из Национальной неврологической больницы в Лондоне обнаружили, что у здоровых людей приток крови в мозг после 33 лет снижается и к 61 году составляет 77% от исходного; это компенсируется тем, что из поступающей в мозг крови более полно извлекается кислород. При болезни Альцгеймера происходит дальнейшее ослабление кровоснабжения мозга, однако дополнительной компенсации, т.е. дальнейшего усиления экстракции кислорода из крови, не происходит. И приток крови, и потребление кислорода мозгом падают до уровня, который на 30% ниже, чем у пожилых людей, не страдающих слабоумием. Эти показатели продолжают снижаться по мере ухудшения клинической картины, особенно сильно в лобных и теменных долях коры головного мозга, где наблюдаются и наиболее глубокие патологические изменения.

Параллельно уменьшается потребление мозгом глюкозы — главного для него источника энергии. Д. Бенсон из Медицинской школы Калифорнийского университета в Лос-Анджелесе показал, что у страдающих болезнью Альцгеймера в каждой из четырех областей коры и в одной области подкорки, которые он смог обследовать, потребляется на 30—50% меньше глюкозы. А у больных, чье слабоумие было следствием множественных микроинсультов, потребление глюкозы падает только в пораженных участках. Дж. Бласс из Медицинского колледжа Корнеллского университета обнаружил, что в образцах мозговой ткани и в культивируемых клетках кожи людей с болезнью Альцгеймера недостаточно фосфофруктокиназы — фермента, не

обходимого для превращения глюкозы в макроэргические интермедиаты (богатые энергией промежуточные продукты метаболизма). Является ухудшение способности мозговой ткани производить химическую энергию причиной или следствием патологического изменения нервных клеток? Конечно, уменьшение в мозгу числа клеток — потребителей кислорода должно в целом ослабить необходимость в его кровоснабжении. Однако наблюдаемое снижение поступающего в мозг объема крови намного превышает величину, которую можно было бы приписать уменьшению массы мозговой ткани.

В чем же причина нарушения кровообращения при болезни Альцгеймера? По данным А. Шейбеля из Медицинской школы Калифорнийского университета в Лос-Анджелесе мелкие нейроны, контролирующие расширение и сжатие артериол мозга, постепенно исчезают и при нормальном старении, но особенно мало их в мозгу больных слабоумием. Несколько лет назад мои коллеги из Массачусетского технологического института и я установили, что у крыс выделение медиатора дофамина может контролировать приток крови к областям мозга, богатым дофамином. Другие исследователи обнаружили, что на кровеносных сосудах имеются специфические рецепторы для ряда различных медиаторов. Это позволяет предполагать, что выделение медиаторов влияет на приток крови к определенным участкам мозга. Возможно, именно из-за утраты нервов, управляющих притоком крови, ограничивается кровоснабжение нейронов при болезни Альцгеймера.

 

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