血压变异性联合胱抑素C水平与血管性认知障碍的研究进展

Research Progress on the Association Between Blood Pressure Variability and Cystatin C Levels in Vascular Cognitive Impairment

摘要

血管性认知障碍（vascular cognitive impairment，VCI）已成为当今老龄化社会面临的重要健康挑战，其核心病理基础在于脑血管的病变。而血压变异性（blood pressure variability，BPV）作为反映血压动态波动的指标，与肾功能敏感标志物胱抑素C（cystatin C，Cys-C）水平，均被证实与VCI密切相关。研究表明，增大的BPV通过损害肾脏血管内皮细胞功能，引发肾脏亚临床损伤与微血管病变，进而导致Cys-C水平升高，升高的Cys-C不仅反映了肾损伤，其本身也可能参与系统性血管炎症与动脉硬化。最终，这种由BPV启动、经肾脏血管内皮功能障碍与Cys-C水平变化所表征的“肾源性”损害，通过加剧脑小血管病（cerebral small vessel disease，CSVD）、神经炎症等多种途径，共同推动了VCI的发生与发展。该文从这一连锁机制的研究进展进行综述，并探讨了联合评估BPV与Cys-C水平在VCI早期识别中的潜在价值。

Abstract

Vascular cognitive impairment (VCI) has emerged as a significant health challenge in today's aging societies, with its core pathological basis rooted in cerebral vascular lesions. Blood pressure variability (BPV), an indicator reflecting dynamic blood pressure fluctuations, and cystatin C (Cys-C) levels—a sensitive marker of renal function—have both been demonstrated to be closely associated with VCI. Research indicates that increased BPV impairs renal vascular endothelial cell function, triggering subclinical renal injury and microvascular pathology. This, in turn, elevates Cys-C levels. Elevated Cys-C not only reflects renal damage but may also contribute to systemic vascular inflammation and atherosclerosis. Ultimately, this “renal-originating” damage—initiated by BPV and characterized by renal vascular endothelial dysfunction and altered Cys-C levels—contributes to the onset and progression of VCI through multiple pathways, including exacerbating cerebral small vessel disease (CSVD) and neuroinflammation. This review summarizes research progress on this chain mechanism and explores the potential value of jointly assessing BPV and Cys-C levels for early identification of VCI.

关键词

血压变异性 / 胱抑素C / 血管性认知障碍 / 肾脏 / 内皮功能障碍

Key words

blood pressure variability / cystatin C / vascular cognitive impairment / kidney / endothelial dysfunction

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