脑小血管病与代谢：危险因素、治疗靶点和未来方向Cerebral Small Vessel Disease and Metabolism: Risk Factors, Therapeutic Targets, and Future Directions

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.