脑内胆固醇与脑小血管病的研究进展
Research Progress on Intracranial Cholesterol and Cerebral Small-Vessel Disease
摘要: 脑小血管病(cerebral small-vessel disease, CSVD)是我国常见的神经系统疾病，起病隐匿但危害深远，随着人口老龄化加剧，其发病率持续上升，给社会和家庭带来沉重负担。CSVD的临床表现异质性强，影像学检查是主要诊断手段，典型表现包括腔隙性脑梗塞(Lacuanar infarct, LI)、脑白质高信号(white matter hyperintensity, WMH)、血管周围间隙扩大(enlarged perivascular space, EPVS)、脑微出血(cerebral microbleed, CMB)等。胆固醇作为可调控的心血管危险因素，其对CSVD的影响及机制与大血管病存在差异，且即使低密度脂蛋白胆固醇(low-density lipoprotein cholesterol, LDL-C)控制在目标范围内，仍存在CSVD发病风险。近年来，胆固醇代谢产物，如24-S-羟基胆固醇(24-S-hydroxycholesterol, 24-OHC)在CSVD中的作用逐渐受到关注。本文综述胆固醇的脑内合成、转运及代谢过程，重点探讨胆固醇及其代谢产物与CSVD典型影像学表现相关的发病机制，并展望未来研究方向与治疗前景，为CSVD的精准干预提供参考。
Abstract: Cerebral small-vessel disease (CSVD) is a common neurological disorder in China. It has an insidious onset but poses serious long-term risks. With the acceleration of population aging, its incidence continues to rise, placing a heavy burden on society and families. The clinical manifestations of CSVD are highly heterogeneous, and imaging examinations serve as the primary diagnostic tools. Typical imaging features include lacunar infarcts (LI), white matter hyperintensity (WMH), enlarged perivascular spaces (EPVS), and cerebral microbleeds (CMB). Cholesterol, as a modifiable cardiovascular risk factor, exerts different effects and mechanisms on CSVD compared to large vessel diseases. Moreover, even when low-density lipoprotein cholesterol (LDL-C) is controlled within target ranges, the risk of CSVD persists. In recent years, cholesterol metabolites, such as 24-S-hydroxycholesterol (24-OHC), have garnered increasing attention for their potential role in CSVD. This article reviews the processes of cholesterol synthesis, transport, and metabolism in the brain, with a focus on exploring the pathogenesis linking cholesterol and its metabolites to typical imaging manifestations of CSVD. It also outlines future research directions and therapeutic prospects, aiming to provide insights for the precise intervention of CSVD.
文章引用：王感恩, 张晓璇. 脑内胆固醇与脑小血管病的研究进展[J]. 临床医学进展, 2026, 16(2): 2123-2129. https://doi.org/10.12677/acm.2026.162610

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