细胞外囊泡在心力衰竭发病机制中的作用：机制与治疗潜力

心力衰竭（HF）仍是全球发病率和死亡率的主要原因之一，这需要对其分子机制有更深入的理解。细胞外囊泡（EVs）——包括外泌体、微囊泡、凋亡小体及其他研究较少的亚型——已成为心血管疾病中关键的细胞间通讯介质。这些纳米级颗粒携带生物活性分子，如蛋白质、脂质和核酸，影响心脏重构、炎症、纤维化和血管生成等过程。

源自心肌细胞、内皮细胞、成纤维细胞和免疫细胞的EVs通过调节病理信号通路促进心力衰竭的进展。例如，心肌细胞来源的EVs可能介导肥大和凋亡，而成纤维细胞来源的EVs则刺激细胞外基质沉积，导致心肌僵硬。相反，某些EV亚群具有心脏保护作用，这凸显了它们在心力衰竭发病机制中的双重作用。本综述总结了当前关于EVs在心力衰竭中的生物发生、组成和功能的认识，并探讨了它们的诊断和治疗潜力。

我们评估了临床前和临床研究的数据，特别关注与EVs相关的生物标志物在心力衰竭早期诊断和预后判断中的应用。此外，我们还探讨了工程化EVs在靶向药物递送方面的临床应用可能性。尽管该领域取得了显著进展，但仍存在未解决的问题：EVs的异质性、缺乏标准化的分离方法以及研究结果在实际应用中的困难。应对这些挑战对于开发心力衰竭治疗的新策略至关重要。通过整合基础研究和临床发现，本综述分析了EVs在心力衰竭中的作用，并评估了其在新型诊断和治疗方法中的应用潜力。

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