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目的:评估近期皮质下小梗死（RSSI）患者的深髓静脉（DMVs）可见性，并探讨其对RSSI伴认知障碍的影响。方法:选择南京医科大学第三附属医院神经内科自2023年2月至2024年5月收治的164例首发RSSI患者为研究对象，按照蒙特利尔认知评估（MoCA）量表评分将其分为认知正常组（78例，MoCA评分≥26分）与认知障碍组（86例，MoCA评分<26分），并在患者的磁敏感加权成像幅度图或最小强度投影图上对DMVs可见性采用视觉评分法进行评估。采用单因素分析比较2组患者间临床资料及DMVs可见性评分的差异，采用多因素Logistic回归分析筛选RSSI患者认知障碍的独立影响因素。采用Spearman秩相关分析检验RSSI患者DMVs评分与MoCA评分及各项认知域评分间的关系，同时采用中介分析探讨总脑白质高信号（WMH）体积、DMVs可见性评分与MoCA评分这三者间的关系。结果:单因素分析显示，认知障碍组患者的DMVs可见性评分、年龄、高血压病比例、脑室旁白质高信号（PWMH）体积、总WMH体积均明显高于认知正常组，体质量指数明显低于认知正常组，差异均有统计学意义（ P<0.05）。多因素Logistic回归分析显示，年龄（ OR=1.069，95% CI：1.017~1.123， P=0.008）、总WMH体积（ OR=1.845，95% CI：1.050~3.241， P=0.033）、DMVs可见性评分（ OR=1.239，95% CI：1.057~1.454， P=0.008）为RSSI伴认知障碍的独立影响因素。Spearman秩相关分析显示，RSSI患者的DMVs可见性评分与MoCA评分（ rs=-0.472， P<0.001）、视空间与执行功能评分（ rs=-0.329， P<0.001）、注意力评分（ rs=-0.491， P<0.001）、延迟回忆评分（ rs=-0.516， P<0.001）、定向力评分（ rs=-0.162， P=0.039）均呈负相关关系。中介分析显示，DMVs可见性评分不仅能对MoCA评分起87.5%的直接效应作用，而且能通过总WMH体积对MoCA评分起12.5%的间接效应作用。 结论:DMVs可见性评分较高的RSSI患者易伴认知障碍。WMH体积在DMVs可见性对RSSI伴认知障碍的影响中起着中介作用。

Objective:To evaluate the visibility of deep medullary veins (DMVs) in patients with recent subcortical small infarction (RSSI), and explore the influence of DMVs visibility in RSSI with cognitive impairment.Methods:One hundred and sixty-four first-onset RSSI patients admitted to Department of Neurology, Third Affiliated Hospital of Nanjing Medical University from February 2023 to May 2024 were selected. According to Montreal cognitive assessment (MoCA), they were divided into normal cognitive function group (MoCA scores≥26, n=78) and cognitive impairment group (MoCA scores<26, n=86); DMVs visibility on amplitude map or minimum intensity projection map in susceptibility weighted imaging was evaluated by visual scoring method. Univariate analysis was used to compare the differences in general clinical data and DMVs visibility scores between two groups; multivariate Logistic regression analysis was used to identify the independent influencing factors for RSSI combined with cognitive impairment. Spearman rank correlation was used to analyze the correlations of DMVs visibility score with MoCA score and cognitive scores in various cognitive domains, while mediation analysis was used to explore the correlations of MoCA score with total white matter hyperintensity (WMH) volume and DMVs visibility score. Results:The DMVs visibility score, age, hypertension proportion, periventricular white matter hyperintensity (PWMH) volume, and total WMH volume in RSSI patients with cognitive impairment were significantly higher, while body mass index (BMI) was statistically lower than those in patients with normal cognitive function ( P<0.05). Multivariate Logistic regression analysis showed that age ( OR=1.069, 95% CI: 1.017-1.123, P=0.008), total WMH volume ( OR=1.845, 95% CI: 1.050-3.241, P=0.033), and DMVs visibility score ( OR=1.239, 95% CI: 1.057-1.454, P=0.008) were independent influencing factors for cognitive impairment in RSSI patients. Spearman rank correlation showed negative correlations between DMVs visibility score and MoCA score ( rs=-0.472, P<0.001), between DMVs visibility score and score of executive function and visual-spatial skills ( rs=-0.329, P<0.001), between DMVs visibility score and attention score ( rs=-0.491, P<0.001), between DMVs visibility score and delayed recall score ( rs=-0.516, P<0.001), and between DMVs visibility score and directional ability score ( rs=-0.162, P=0.039) in RSSI patients. Mediation analysis results showed that DMVs visibility score not only had a direct effect of 87.5% on MoCA score, but also had an indirect effect of 12.5% on MoCA score through total WMH volume. Conclusion:Cognitive impairment trend to appear in RSSI patients with high DMVs visibility score, and WMH volume plays a mediating role in the effect of DMVs visibility on RSSI with cognitive impairment.