1.黑龙江中医药大学基础医学院,哈尔滨 150040
2.哈尔滨医科大学基础医学院,哈尔滨 150081
Received:06 May 2026,
Revised:2026-07-21,
Accepted:20 August 2026,
Published:27 October 2026
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Gao Qiang,Lü Lifang.Research progress on the relationship between atherosclerosis-related cerebrovascular injury and Alzheimer’s disease[J].Journal of Chongqing Medical University,
Gao Qiang,Lü Lifang.Research progress on the relationship between atherosclerosis-related cerebrovascular injury and Alzheimer’s disease[J].Journal of Chongqing Medical University, DOI:10.13406/j.cnki.cyxb..
动脉粥样硬化(atherosclerosis,AS)相关脑血管损害是连接血管病变与阿尔茨海默病(Alzheimer’s disease,AD)的重要环节。临床队列、影像学和病理学研究提示,颈动脉内膜中层厚度增加、颈动脉斑块、Willis环AS、动脉僵硬和脑低灌注等改变,与认知下降、痴呆风险及AD相关病理负荷有关。其潜在机制包括β-淀粉样蛋白(amyloid-β,Aβ)生成与清除失衡、微管相关蛋白Tau(microtubule-associated protein tau,Tau)异常、脂质代谢紊乱、载脂蛋白E(apolipoprotein E,APOE)ε4相关易感性、血脑屏障(blood-brain barrier,BBB)和神经血管单元(neurovascular unit,NVU)功能障碍、慢性炎症及氧化应激等。现有证据支持将血压、血脂和血糖等血管危险因素管理及生活方式干预用于认知下降风险管理;APOE ε4携带状态可反映AD遗传易感性,并与AS相关血管风险有关,但其单独用于临床AS风险识别或与血管风险指标联合预测AD风险的价值仍需验证;针对Aβ/Tau、炎症和Aβ跨BBB转运等靶点的策略仍以临床前或早期探索为主。本文从关联证据、潜在共同机制和风险识别与干预启示三个方面综述AS相关脑血管损害与AD的关系,并区分不同结局和证据层级,以避免过度解释现有研究结果。
Atherosclerosis (AS)-related cerebrovascular injury is an important link between vascular lesions and Alzheimer’s disease (AD). Clinical cohort,imaging,and pathological studies suggest that increased carotid intima-media thickness,carotid plaques,AS of the circle of Willis,arterial stiffness,and cerebral hypoperfusion are associated with cognitive decline,risk of dementia,and AD-related pathological burden. Potential mechanisms include an imbalance between β-amyloid production and clearance,microtubule-associated protein tau abnormalities,lipid dysregulation,apolipoprotein E ε4-related susceptibility,blood-brain barrier and neurovascular unit dysfunction,chronic inflammation,and oxidative stress. Current evidence supports the application of vascular risk factor management,such as blood pressure,blood lipids,and blood glucose,as well as lifestyle interventions for the management of the risk of cognitive decline. Apolipoprotein E ε4 carrier status may reflect genetic susceptibility to AD and is associated with AS-related vascular risk; however,its value in clinical identification of the risk of AS when used alone or in prediction of the risk of AD when used in combination with vascular risk indicators still needs to be validated. Strategies targeting β-amyloid/microtubule-associated protein tau,inflammation,and β-amyloid transport across the blood-brain barrier are still mainly preclinical or in early exploration. This article reviews the relationship between AS-related cerebrovascular injury and AD from three aspects:evidence of association,potential common mechanisms,and implications for risk identification and intervention,and distinguishes different outcomes and levels of evidence to avoid overinterpretation of existing findings.
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