下肢动脉硬化闭塞症对下肢肌肉组织的影响

The Impact of Lower Limb Arteriosclerosis Obliterans on Lower Limb Muscle Tissue

摘要: 下肢动脉硬化闭塞症(ASO)是全身性动脉粥样硬化在下肢的表现，其核心病理生理是下肢动脉血流的进行性减少。慢性缺血不仅导致间歇性跛行、静息痛等临床症状，更对作为终末效应器的下肢骨骼肌造成深远的、结构性损害。本文系统综述了ASO所致下肢肌肉损伤的病理生理通路，包括缺血缺氧、氧化应激、慢性炎症与线粒体功能障碍的交织作用；详细描述了肌肉组织在细胞、亚细胞及分子水平上的病理变化，如肌纤维萎缩、类型转化、纤维化及再生障碍；并探讨了这些改变的最终临床结局——功能障碍、生活质量下降与截肢风险。结合单细胞与空间转录组学的前沿发现，揭示肌肉微环境的细胞异质性与分子空间特征。最后，本文指出了该领域的研究创新点与现有不足，以期为未来的基础研究与临床实践提供参考。

Abstract: Lower extremity arteriosclerosis obliterans (ASO) is a manifestation of systemic atherosclerosis in the lower limbs, with the core pathophysiology being progressive reduction of arterial blood flow in the lower extremities. Chronic ischemia not only leads to clinical symptoms such as intermittent claudication and rest pain, but also causes profound structural damage to the lower limb skeletal muscles, which act as end-effectors. This article systematically reviews the pathophysiological pathways of lower limb muscle injury caused by ASO, including the interplay of ischemia-hypoxia, oxidative stress, chronic inflammation, and mitochondrial dysfunction; it provides a detailed account of pathological changes in muscle tissue at the cellular, subcellular, and molecular levels, such as muscle fiber atrophy, fiber-type switching, fibrosis, and impaired regeneration; and it explores the ultimate clinical outcomes of these changes—functional impairment, reduced quality of life, and risk of amputation. Incorporating cutting-edge findings from single-cell and spatial transcriptomics, this review reveals the cellular heterogeneity and molecular spatial characteristics of the muscle microenvironment. Finally, this paper highlights research innovations and current gaps in this field, aiming to provide references for future basic research and clinical practice.