淀粉样蛋白相关影像学异常（amyloid-related imaging abnormalities， ARIA）是仑卡奈单抗治疗阿尔茨海默病（Alzheimer’s disease， AD）过程中需关注的重要安全性风险，其发生与多种因素相关。本文报道1例77岁的男性AD患者，在接受仑卡奈单抗治疗6个月后出现淀粉样蛋白相关影像学水肿（ARIA with edema and effusion， ARIA-E）和出血（ARIA with haemorrhage， ARIA-H）表现。该患者携带ApoE ε3/ε4杂合基因型，存在类淋巴系统功能受损，且长期服用抗栓药物等ARIA风险因素。治疗期间患者虽出现影像学异常，但认知功能保持稳定，血清胶质纤维酸性蛋白（glial fibrillary acidic protein， GFAP）浓度降低。经评估并予糖皮质激素干预后，患者继续使用仑卡奈单抗治疗，治疗过程平稳。复习知网、万方及PubMed数据库，共检索到8例ARIA病例报道，男女各4例，中位年龄72岁，其中至少6例为ApoE ε3/ε4（3例）或ApoE ε2/ε3（3例）杂合型，以轻、中度ARIA-E（3例）和（或）ARIA-H（3例）表现为主。综合文献，ARIA发生风险包括ApoEε3/ε4杂合型、长期服用抗栓药物、基线存在微出血灶和白质病变，而本例患者提示类淋巴系统受损也可能是其风险因素。本案例提示，对于具有多重ARIA风险因素的患者，通过规范影像学监测，及时识别、干预，并综合评估获益和风险，可实现安全、持续的疾病修饰治疗，为临床个体化管理提供实践依据。

Amyloid-related imaging abnormalities (ARIA) represent a significant safety concern that requires attention during the treatment of Alzheimer's disease (AD) with lecanemab, and their occurrence is associated with multiple factors. This paper reports the case of a 77-year-old male patient with AD who developed manifestations of both ARIA with edema and effusion (ARIA-E) and ARIA with haemorrhage (ARIA-H) after six months of lecanemab treatment. The patient carried ARIA risk factors, including the ApoE ε3/ε4 heterozygous genotype, impaired glymphatic system function, and long-term use of antithrombotic medication. Although imaging abnormalities emerged during treatment, the patient's cognitive function remained stable, and his serum glial fibrillary acidic protein (GFAP) concentration decreased. Following assessment and glucocorticoid intervention, the patient continued lecanemab treatment, and the treatment course remained stable. A review of the CNKI, Wanfang, and PubMed databases identifies a total of 8 reported ARIA cases, comprising 4 males and 4 females with a median age of 72 years. Among these, at least 6 cases are heterozygous for ApoE ε3/ε4 (3 cases) or ApoE ε2/ε3 (3 cases). The predominant manifestations are mild to moderate ARIA-E (3 cases) and/or ARIA-H (3 cases). The literature indicates that the ARIA risk factors included the ApoE ε3/ε4 heterozygous genotype, long-term use of antithrombotic medication, and the presence of microbleeds and white matter lesions at baseline. Furthermore, this case suggests that glymphatic system impairment may also be a potential risk factor. This case suggests that for patients with multiple ARIA risk factors, standardized imaging monitoring, timely identification and intervention, and comprehensive benefit-risk assessment can achieve safe and continuous disease-modifying therapy, providing a practical basis for individualized clinical management.