脑小血管病的红细胞-血流动力学调控： 病理机制与靶向干预新策略

张 荣福, 孙 娟*
青海大学附属医院

摘要


脑小血管病（Cerebral Small Vessel Disease，CSVD）是一种累及脑内微小血管的慢性病变，以脑白质高信
号、腔隙性脑梗死及微出血为典型影像学特征，是血管性痴呆和缺血性卒中的主要病因，全球约7亿老年人受累，
中国老龄化加剧进一步加重其疾病负担。研究表明，红细胞特性（如变形能力降低、血红蛋白浓度异常）通过调节
颈动脉血流动力学（如血流速度、搏动指数）影响脑微循环，参与CSVD病理进程。慢性低灌注、氧化应激、炎症
级联反应及血脑屏障破坏是核心机制，其中红细胞膜刚性增加、TLR4/NF-κB通路激活、血脑屏障（Blood-Brain
Barrier，BBB）紧密连接蛋白降解等加剧神经元损伤和白质病变。当前临床干预聚焦于高血压控制、红细胞流变学
优化（如己酮可可碱改善变形能力）及血红蛋白浓度调控。未来需开发精准靶向治疗（如SIRT1/AMPK激活剂、
MMP-9抑制剂），结合多模态生物标志物（血流动力学参数+红细胞指数）和人工智能技术，推动早期筛查与个体
化治疗。转化医学需突破分子互作机制验证及多中心临床试验设计，以降低CSVD致残率和疾病负担。

关键词


脑小血管病；红细胞变形能力；颈动脉血流动力学；血脑屏障

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参考


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