脑小血管病与残余胆固醇的关系研究进展

Research Progress on the Relationship between Cerebral Small Vessel Disease and Remnant Cholesterol

摘要: 近年来，围绕脑小血管病危险因素及发病机制的临床和实验研究发现，仅仅控制低密度脂蛋白这一危险因素后仍有脑小血管病发生与进展的风险，近年来关于残余胆固醇的研究发现其是心血管疾病的剩余危险因素，且残余胆固醇也与急性缺血性脑卒中的发生与发展有一定关系，但国内对残余胆固醇与脑小血管病关系的研究相对匮乏。本综述旨在系统性地梳理和整合当前关于RC与CSVD关系的研究进展。本文首先详细阐述CSVD的传统及新兴危险因素，明确RC在其中的潜在定位。其次解析RC的生物学定义、介导动脉粥样硬化的病理生理机制。在此基础上，本综述的核心部分将重点分析RC在CSVD病理生理学中的多重作用，包括血管内皮功能障碍、血脑屏障破坏、神经炎症与氧化应激等等核心病理环节中的调控机制。并探讨RC水平与CSVD不同影像学亚型的关联性，并结合临床研究证据进行综合评述。最后，本文讨论RC作为CSVD防治新靶点的潜在价值、面临的挑战及未来的研究方向，以期为揭示CSVD的发病机制、开发新型干预策略提供科学依据与理论参考。

Abstract: In recent years, clinical and experimental studies on the risk factors and pathogenesis of cerebral small vessel disease (CSVD) have found that there is still a risk of the occurrence and progression of CSVD even after only controlling low-density lipoprotein, a single risk factor. Recent studies on remnant cholesterol (RC) have identified it as a remnant risk factor for cardiovascular diseases, and RC is also associated with the occurrence and development of acute ischemic stroke. However, domestic research on the relationship between RC and CSVD is relatively scarce. This review aims to systematically sort out and integrate the current research progress on the relationship between RC and CSVD. First, this article elaborates in detail on the traditional and emerging risk factors of CSVD, and clarifies the potential position of RC among them. Second, it deeply analyzes the definition and pathophysiological mechanisms of atherogenesis of RC. On this basis, the core part of this review will focus on analyzing the multiple roles of RC in the pathophysiology of CSVD, including key links such as vascular endothelial dysfunction, blood-brain barrier disruption, neuroinflammation, and oxidative stress. It also explores the correlation between RC levels and different imaging subtypes of CSVD, and conducts a comprehensive review combined with clinical research evidence. Finally, this article discusses the potential value, challenges, and future research directions of RC as a new target for the prevention and treatment of CSVD, providing a scientific basis and theoretical reference for revealing the pathogenesis of CSVD and developing new intervention strategies.