铁代谢与脑小血管病的研究进展

Research Progress of Iron Metabolism and Cerebral Small Vascular Disease

摘要: 近年来，随着人口老龄化的加快、神经影像学技术的普及和广泛应用，具有高隐袭性、高发病率、高致残率的脑小血管病(Cerebral small vessel disease, CSVD)逐渐被发现且被人们所重视，但目前其发病机制尚未明确，既往有研究发现CSVD因血脑屏障破坏及大脑缺血缺氧导致脑铁含量增多，铁过载能通过芬顿反应，产生大量自由基，引起脂质过氧化，导致神经元死亡、认知能力下降。同时，铁元素具有升压作用，且可能是糖尿病的标志性元素，糖尿病患者血清铁蛋白水平明显升高，而高血压、糖尿病，特别是高血压是CSVD及其所致认知障碍的主要危险因素。并且通过铁螯合剂(去铁胺、去铁酮)治疗CSVD可延缓细胞、神经损害及神经退变的发生，取得显著疗效。因此铁代谢紊乱可能与CSVD发生发展有关，然而，目前这方面文献报道较少，现就铁代谢与CSVD的研究进展进行综述。

Abstract: In recent years, with the acceleration of the aging of the population, the popularization and wide application of neuroimaging technology, Cerebral small vessel disease (CSVD) with high insidious, high incidence, high disability rate has been gradually discovered and paid attention to, but its pathogenesis has not been clear. Previous studies have found that CSVD results in increased brain iron content due to the destruction of blood-brain barrier and cerebral ischemia and hypoxia. Iron overload can generate a large number of free radicals through fenton reaction, resulting in lipid peroxidation, neuronal death and cognitive decline. At the same time, iron has a hypertensive effect and may be a hallmark element of diabetes. Serum ferritin level in diabetes patients is significantly increased, while hypertension and diabetes, especially hypertension, are the main risk factors for CSVD and the cognitive impairment caused by it. In addition, the treatment of CSVD with iron che-lating agent (deferroamine, deferroone) can delay the occurrence of cell and nerve damage and nerve degeneration, and achieve significant curative effect. Therefore, iron metabolism disorder may be related to the occurrence and development of CSVD. However, there are few studies on this aspect at present. This paper reviews the research progress of iron metabolism and CSVD.