肥胖对下肢慢性静脉疾病发生发展及治疗结局影响的研究进展

Research Progress on the Effects of Obesity on the Development, Progression, and Treatment Outcomes of Chronic Venous Disease of the Lower Extremities

摘要: 肥胖与下肢慢性静脉疾病均具有较高的疾病负担。现有流行病学研究提示，身体质量指数升高与静脉反流、慢性静脉功能不全、皮肤改变及静脉性溃疡风险增加相关。肥胖可能通过升高腹腔内压力、降低下肢静脉流速及剪切应力、削弱小腿肌肉泵功能，并促进慢性低度炎症和淋巴回流障碍，影响慢性静脉疾病的发生和进展。肥胖还可能增加临床检查、压力治疗和静脉介入操作的难度，但其对腔内消融闭塞率、血栓形成及复发风险的影响尚不一致。体重管理可能改善症状和整体代谢状况，但目前缺乏证据证明单纯减重能够逆转器质性静脉瓣膜功能不全。本文围绕肥胖与下肢慢性静脉疾病的流行病学关联、可能机制、治疗结局及体重管理价值进行综述，为风险分层和综合管理提供参考。

Abstract: Obesity and chronic venous disease of the lower extremities both impose substantial disease burdens. Current epidemiological evidence suggests that an elevated body mass index is associated with an increased risk of venous reflux, chronic venous insufficiency, skin changes, and venous leg ulcers. Obesity may contribute to the development and progression of chronic venous disease by increasing intra-abdominal pressure, reducing venous flow velocity and shear stress in the lower extremities, impairing calf muscle pump function, and promoting chronic low-grade inflammation and lymphatic dysfunction. Obesity may also increase the difficulty of clinical examination, compression therapy, and venous interventions. However, its effects on occlusion rates after endovenous ablation, thrombotic events, and recurrence remain inconsistent. Weight management may improve symptoms and overall metabolic health, but current evidence is insufficient to demonstrate that weight loss alone can reverse structural venous valvular incompetence. This review summarizes the epidemiological associations, potential mechanisms, treatment outcomes, and clinical value of weight management in obesity-related chronic venous disease, with the aim of providing evidence for risk stratification and comprehensive management.