Anaerobic ammonium oxidation (anammox) as a low-carbon and energy-saving technology, has shown unique advantages in the treatment of high ammonia wastewater. However, wastewater usually contains complex heavy metals (HMs), which pose a potential risk to the stable operation of the anammox system. This review systematically re-evaluates the HMs toxicity level from the inhibition effects and the inhibition recovery process, which can provide a new reference for engineering. From the perspective of anammox cell structure (extracellular, anammoxosome membrane, anammoxosome), the mechanism of HMs effects on cellular substances and metabolism is expounded. Furthermore, the challenges and research gaps for HMs inhibition in anammox research are also discussed. The clarification of material flow, energy flow and community succession under HMs shock will help further reveal the inhibition mechanism. The development of new recovery strategies such as bio-accelerators and bio-augmentation is conductive to breaking through the engineered limitations of HMs on anammox. This review provides a new perspective on the recognition of toxicity and mechanism of HMs in the anammox process, as well as the promotion of engineering applicability.

厌氧氨氧化（anammox）作为一种低碳节能技术，在处理高氨废水方面显示出独特的优势。然而，废水通常含有复杂的重金属（HMs），这对厌氧氨氧化系统的稳定运行构成潜在风险。该综述从抑制作用和抑制恢复过程两个方面系统地重新评价了HMs的毒性水平，可为工程化提供新的参考。从厌氧氨氧化细胞结构（细胞外、厌氧氨氧化体膜、厌氧氨氧化体）的角度阐述了HMs影响细胞物质和代谢的机制。此外，还讨论了厌氧氨氧化研究中 HMs 抑制的挑战和研究差距。物料流的澄清，HMs冲击下的能量流动和群落演替将有助于进一步揭示抑制机制。开发新的回收策略，如生物加速器和生物强化，有助于突破 HMs 对厌氧氨氧化的工程限制。该综述为HMs在厌氧氨氧化过程中的毒性和机制的认识以及工程应用的推广提供了新的视角。