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明确脑小血管病（cerebral small vessel disease，CSVD）的代谢危险因素并进行及时、系统的管控至关重要。目前残余代谢危险因素与CSVD的相关性尚存争议，而靶向危险因素治疗CSVD的临床效果尚缺乏循证依据。本文综合分析炎症、肠道菌群紊乱、高同型半胱氨酸血症及高尿酸血症等残余代谢危险因素与CSVD发生、发展的相关性，进一步探讨靶向代谢危险因素的潜在治疗方案，强调代谢组学在CSVD新型代谢生物标志物发现和风险预测模型建立中的重要作用，并展望未来研究方向，为CSVD的早期诊断、机制探索、危险因素管控和多学科综合管理提供理论依据。 Abstract: It is crucial to identify the metabolic risk factors of cerebral small vessel disease (CSVD) and implement timely and systematic management. Currently, the correlation between residual metabolic risk factors and CSVD is still controversial, and there’s a lack of evidence-based support for the clinical efficacy of targeting risk factors in treating CSVD. This paper comprehensively analyzes the correlation between residual metabolic risk factors such as inflammation, gut microbiota dysbiosis, hyperhomocysteinemia, and hyperuricemia with the occurrence and development of CSVD. It further explores potential therapeutic options targeting metabolic risk factors, emphasizes the important role of metabolomics in the discovery of novel metabolic biomarkers and the establishment of risk prediction models for CSVD, and looks forward to future research directions, to provide a theoretical basis for the early diagnosis, mechanism exploration, risk factor management, and comprehensive multidisciplinary management of CSVD.

代谢性脑血管病是一个新近提出的概念，指由传统代谢危险因素和残余代谢危险因素引起的脑血管损害，通过干预代谢危险因素可有效改善其预后的一种临床综合征。代谢途径并非独立存在，脑、心脏、肝脏、肾脏和肠道等多个器官的各种代谢途径相互影响、共同作用、交织成网，构成了人体的代谢网络，而代谢网络的异常导致了代谢性脑血管病的发生。同时，代谢危险因素的存在可同时造成多个靶器官损害，且神经系统与心血管系统、内分泌系统、消化系统等可通过多种病理生理过程相互影响。因此，代谢性脑血管病未来在机制探究和疾病治疗等方面将逐渐倾向于多器官水平，并向多学科管理模式发展。 Abstract: Cerebro-metabolic disease is a recently proposed concept primarily referring to cerebrovascular injury caused by both traditional and residual metabolic risk factors. It represents a clinical syndrome in which intervention in metabolic risk factors can effectively improve the prognosis. Metabolic pathways do not exist independently. Various metabolic pathways in multiple organs such as the brain, heart, liver, kidneys, and intestines interact, collaborate, and intertwine to form the metabolic network of the human body. The abnormality in the metabolic network leads to the occurrence of cerebro-metabolic disease. Moreover, the presence of metabolic risk factors can simultaneously cause injury to multiple target organs, and the nervous system interacts with the cardiovascular system, endocrine system, digestive system, and others through various pathophysiological processes. Therefore, future research on cerebro-metabolic disease will gradually tend to multi-organ level in mechanism exploration and disease treatment, and develop into a multidisciplinary management approach.

代谢危险因素是导致心脑血管病的重要原因。目前代谢性心血管病已有明确的概念和综合管理体系，而在我国发病率高、异质性强的脑血管病领域，尚未形成统一的代谢性脑血管病的定义和概念。本文综述脑血管病的代谢危险因素，提出代谢性脑血管病的概念和分类，阐述基于多组学技术的多学科、多器官水平的研究方法，介绍近年来涌现的具有心血管获益的代谢药物的特点及未来面临的挑战和研究方向，为代谢性脑血管病的综合管理提供理论依据。 Abstract: Metabolic risk factors are important causes of cardiovascular and cerebrovascular diseases. There is already a definite concept and comprehensive management system for cardio-metabolic disease. While the incidence rate of stroke is higher and exhibit greater heterogeneity in China, and lacks a concept of cerebro-metabolic disease currently. Therefore, we reviewed the metabolic risk factors of stroke, proposed the concept and classification of cerebro-metabolic disease, elucidated the interdisciplinary and multi-organ level research methods based on multi-omics technology, introduced the characteristics of recently emerged metabolic drugs with cardiovascular benefits and the challenges and future directions. We aimed to provide a theoretical basis for the comprehensive management of cerebro-metabolic disease.