老年共病管理的突破口:从脑血管病到脑心共病的理念跃升OA
Moving beyond cerebrovascular disease:integrated brain-heart care as the new entry point for managing multimorbidity in older adults
人口老龄化与慢性病谱变化使老年共病逐渐成为卒中防治和老年医学共同面对的核心议题.脑心共病(brain-heart multimorbidity)是老年共病中最具临床代表性且最富挑战性的表型之一,体现为脑血管病与心血管病在危险因素、病理基础、急性事件、远期预后及治疗策略上的深度交织.本文从概念演进与临床表型出发,将脑心共病归纳为脑心共患、脑心互作与脑心互斥3类临床分型.以动脉粥样硬化为核心病理基础,系统梳理了免疫炎症、内皮损伤、血栓形成、神经内分泌调控及肠道微生物群等介导脑心共病的病理生理机制.在此基础上,剖析了我国在流行病学证据、机制研究、临床诊疗模式、多重用药管理和卫生服务体系方面存在的关键短板.本综述提出,脑心共病防治亟需从"单病种、单系统"的传统理念向"多病共存、全程管理、个体化决策"的新理念转变,应以多学科协同为组织基础,结合机制研究与真实世界证据,构建符合中国国情的脑心共病防治体系.脑心共病作为老年共病的缩影,其防治理念的转变可为推动老年共病从单病种叠加管理走向多系统整合治理提供方法学启示,并对降低老年人群心脑血管事件负担、维护功能独立与生命质量具有重要意义.
Population aging and changes in the chronic disease spectrum have gradually made geriatric multimorbidity a central issue confronting stroke care and geriatric medicine.Brain-heart multimorbidity is one of the most clinically representative and challenging phenotypes of geriatric multimorbidity,characterized by a deep intertwining of cerebrovascular and cardiovascular diseases across risk factors,pathological basis,acute events,long-term prognosis,and treatment strategies.Drawing on conceptual evolution and clinical phenotypes,this review classifies brain-heart multimorbidity into 3 clinical subtypes:brain-heart co-occurrence,brain-heart interaction,and brain-heart conflict.Taking atherosclerosis as the core pathological basis,this review systematically examines the pathophysiological mechanisms underlying brain-heart multimorbidity,including immune-mediated inflammation,endothelial injury,thrombosis,neuroendocrine dysregulation,and gut microbiota imbalance.On this basis,it analyzes critical gaps in China regarding epidemiological evidence,mechanistic research,clinical diagnosis and treatment models,polypharmacy management,and health service systems.This review proposes that prevention and treatment of brain-heart multimorbidity urgently need to shift from the traditional single-disease,single-system paradigm to a new framework of multiple coexisting diseases,whole-course management,and individualized decision-making.Such a framework should be anchored in multidisciplinary collaboration and integrate mechanistic research with real-world evidence to build a brain-heart multimorbidity prevention and treatment system tailored to China's national conditions.As a microcosm of geriatric multimorbidity,this conceptual shift can provide methodological insights for moving geriatric multimorbidity from stacked single-disease management toward integrated multi-system governance,and is of great significance for reducing the burden of cardiovascular and cerebrovascular events in older adults and maintaining functional independence and quality of life.
杨清武;孔维麟
陆军军医大学(第三军医大学)第二附属医院神经内科,重庆陆军军医大学(第三军医大学)第二附属医院神经内科,重庆
医药卫生
老年共病脑心共病防治理念
geriatric multimorbiditybrain-heart multimorbidityprevention and treatment paradigms
《陆军军医大学学报》 2026 (16)
2233-2242,10
国家自然科学基金重大项目(82090040) Supported by the Major Program of the National Natural Science Foundation of China(82090040).
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