阿尔茨海默病是一种起病隐匿、呈进行性发展的神经退行性疾病。近期的研究表明，载脂蛋白E4（APOE4）为阿尔茨 海默病遗传因素的高风险因子，以APOE4分子为主要表征的阿尔茨海默病患者的临床症状与代谢紊乱密切相关。该文综述 了APOE4在阿尔茨海默病发病机制中的作用，即可致大脑血脑屏障受损、与大脑糖脂代谢异常相关、破坏小胶质细胞的清 除能力，并基于该发病机制探讨了中医药早期干预思路。该文提出，基于阿尔茨海默病本虚标实的病机特点及中医未病先 防的理念，针对APOE4为表征的代谢紊乱型阿尔茨海默病患者，中医药早期干预可通过改善痰湿体质、关注胰岛素抵抗相 关指标、辨证分型基础上的中医药疗法或同时采取与运动、饮食、药物干预相结合的综合方式等，以降低或延迟APOE4表 型阿尔茨海默症患者的发病。

Alzheimer 􀆳 s disease（AD） is a progressive neurodegenerative disease with hidden onset. Recent researches have shown that apolipoprotein E4（APOE4）is a high-risk genetic factor of AD， and the clinical symptoms in APOE4 genotype AD patients are closely related to metabolic disorders. This paper reviewed the role of APOE4 in the pathogenesis of AD，and it is indicated that APOE4 contributes to the injury of the cerebral bloodbrain barrier，is associated with the disorder of cerebral glucose and lipid metabolism，and leads to the damage of the scavenging ability of microglia. Moreover，this paper explored the approach of early intervention of AD with traditional Chinese medicine（TCM）based on the APOE4 pathogenesis. Based on the pathogenesis of AD being deficiency in origin and excess in superficiality， and under the guidance of the principle of prevention before illness in TCM， it is proposed that early TCM intervention for APOE4 genotype AD patients with metabolic disorders can be performed through improving the phlegm-dampness constitution， by focusing on insulin resistance-related indicators, and with traditional Chinese drug therapy based on syndrome differentiation alone or together with comprehensive management of exercises，diet control and drug interventions，thus to reduce or delay the onset of APOE4 genotype AD.

R277.742

国家自然科学基金项目（编号：81273897）