左侧海马CA4区血脑屏障通透性升高与卒中后认知障碍的关系

doi:10.3969/j.issn.1006-7795.2026.01.007

首都医科大学学报 ›› 2026, Vol. 47 ›› Issue (1): 54-61.doi: 10.3969/j.issn.1006-7795.2026.01.007

左侧海马CA4区血脑屏障通透性升高与卒中后认知障碍的关系

王帅国¹,王子豪³,荆京²,林金嬉²,孟霞^2*

1.雄安宣武医院神经内科，河北雄安新区 070001；2.首都医科大学附属北京天坛医院神经病学中心国家神经系统疾病临床医学研究中心，北京 100070；3.海南医科大学，海南医科大学附属海南医院，海口 570000

收稿日期:2025-10-14 修回日期:2025-11-25 出版日期:2026-02-21 发布日期:2026-02-02
通讯作者: 孟霞 E-mail:mengxia45@163.com
基金资助:
国家自然科学基金项目（U20A20358）。

Increased blood-brain barrier permeability in the left hippocampal CA4 region is associated with post-stroke cognitive impairment

Wang Shuaiguo¹， Wang Zihao³， Jing Jing²， Lin Jinxi²， Meng Xia^2*

1.Department of Neurology, Xiongan Xuanwu Hospital, Xiongan New Area 070001, Hebei Province, China；2.National Clinical Research Center for Neurological Diseases, Department of Neurology， Beijing Tiantan Hospital, Capital Medical University, Beijing 100070， China；3.Hainan Medical University, Hainan Medical University Hainan Hospital, Haikou 570000, China

Received:2025-10-14 Revised:2025-11-25 Online:2026-02-21 Published:2026-02-02
Supported by:
This study was supported by National Natural Science Foundation of China (U20A20358).

摘要/Abstract

摘要： 目的探索左侧海马阿蒙角4（cornu ammonis 4, CA4）区血脑屏障（blood-brain barrier，BBB）通透性与卒中后认知障碍（post-stroke cognitive impairment，PSCI）之间的关系。方法本研究为多中心前瞻性队列研究，连续纳入97例短暂性脑缺血发作（transient ischemic attack，TIA）/轻型缺血性卒中患者。入院7 d内行动态对比增强磁共振成像，基于Patlak模型计算海马亚区BBB通透性参数——容积转运常数（volume transfer constant, Ktrans）。根据随访6个月时蒙特利尔认知评估量表 (Montreal Cognitive Assessment，MoCA) 评分，将患者分为PSCI与卒中后非认知障碍（post-stroke non-cognitive impairment，PSNCI）组。采用多因素Logistic回归探讨左侧海马CA4区BBB通透性与认知结局的关系。结果 65例患者完成随访，其中PSCI组13例（20.0%）。PSCI组患者年龄大、教育年限短、基线MoCA评分低（P＜0.05）。左侧海马CA4区BBB通透性升高与MoCA总分下降相关，并与执行功能和命名能力评分呈负相关。左侧海马CA4区BBB通透性升高是PSCI的独立危险因素。结论左侧海马CA4区BBB通透性升高与TIA/轻型缺血性卒中患者6个月时的认知评分较低独立相关，可作为预测PSCI的潜在影像学标志物。

关键词: 卒中后认知障碍, 短暂性脑缺血发作, 轻型缺血性卒中, 血脑屏障, 海马CA4区, 动态对比增强磁共振成像

Abstract: Objective To investigate the association between blood-brain barrier (BBB) permeability in the left hippocampal cornu ammonis 4 (CA4) subregion and post-stroke cognitive impairment (PSCI). Methods This multicenter prospective cohort study consecutively enrolled 97 patients with transient ischemic attack (TIA) or minor ischemic stroke. Within 7 d of admission, all participants underwent dynamic contrast-enhanced magnetic resonance imaging, and BBB permeability parameters volume transfer constant(Ktrans) of hippocampal subregions were calculated using the Patlak model. According to Montreal Cognitive Assessment (MoCA) scores at 6-month follow-up, patients were divided into the PSCI group and the post-stroke non-cognitive impairment (PSNCI) group. Multivariate Logistic regression analysis was performed to examine the independent association between BBB permeability in the left hippocampal CA4 region and cognitive outcomes. Results A total of 65 patients completed the follow-up, including 13 (20.0%) in the PSCI group. Patients in the PSCI group were older, had fewer years of education, and lower baseline MoCA scores (all P < 0.05). Increased BBB permeability in the left hippocampal CA4 region was associated with lower total MoCA scores, and negatively correlated with executive and naming function scores. Multivariate Logistic regression analysis indicated that elevated BBB permeability in the left hippocampal CA4 region was an independent risk factor for PSCI. Conclusion Increased BBB permeability in the left hippocampal CA4 subregion is independently associated with lower cognitive scores at 6 months in patients with TIA or minor ischemic stroke. It may serve as a potential imaging biomarker for predicting PSCI.

Key words: post-stroke cognitive impairment, transient ischemic attack, minor ischemic stroke, blood-brain barrier, hippocampal CA4 subregion, dynamic contrast-enhanced magnetic resonance imaging

中图分类号:

R743

王帅国, 王子豪, 荆京, 林金嬉, 孟霞. 左侧海马CA4区血脑屏障通透性升高与卒中后认知障碍的关系[J]. 首都医科大学学报, 2026, 47(1): 54-61.

Wang Shuaiguo, Wang Zihao, Jing Jing, Lin Jinxi, Meng Xia. Increased blood-brain barrier permeability in the left hippocampal CA4 region is associated with post-stroke cognitive impairment[J]. Journal of Capital Medical University, 2026, 47(1): 54-61.

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左侧海马CA4区血脑屏障通透性升高与卒中后认知障碍的关系

Increased blood-brain barrier permeability in the left hippocampal CA4 region is associated with post-stroke cognitive impairment

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