血管周围脂肪组织功能失调在冠状动脉微血管疾病中的作用研究进展

Research progress on the role of perivascular adipose tissue dysfunction in coronary microvascular disease

摘要:

冠状动脉微血管疾病（CMVD）是影响心肌灌注的重要病理状态，常表现为心绞痛及缺血相关症状，但冠状动脉造影通常未见显著管腔狭窄。近年来研究发现，血管周围脂肪组织（PVAT）不仅是血管的结构支撑组织，更是一种活跃的内分泌与旁分泌器官，能够通过调控免疫细胞极化、脂肪细胞表型、炎症反应及氧化应激等多种机制参与微血管功能调控。PVAT功能失调已被认为是CMVD发生、发展的关键因素。该文基于最新基础与临床研究，系统总结了CMVD的疾病机制、PVAT的解剖及功能特征、在CMVD中的作用机制，以及潜在干预策略，并提出未来研究方向，以期为CMVD的精准防治提供理论依据与实践指导。

Abstract:

Coronary microvascular disease (CMVD) represents a critical pathological condition that impairs myocardial perfusion, typically manifesting as angina and ischemia-related symptoms despite the absence of significant epicardial coronary stenosis on angiography. Recent studies have redefined perivascular adipose tissue (PVAT) not merely as a passive structural component of the vasculature but as a metabolically active endocrine and paracrine organ. PVAT exerts multifaceted regulatory effects on vascular homeostasis by modulating immune cell polarization, adipocyte phenotypic transformation, inflammatory signaling, and oxidative stress. Dysfunction of PVAT has emerged as a pivotal contributor to the onset and progression of CMVD. This review synthesizes recent advances from both experimental and clinical studies, focusing on the pathophysiological mechanisms of CMVD, the anatomical and functional characteristics of PVAT, its mechanistic role in microvascular regulation, and potential therapeutic strategies targeting PVAT. Furthermore, perspectives on future research directions are proposed to provide theoretical and practical insights for the precise prevention and management of CMVD.