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ObjectiveTo investigate the diagnostic value of trimethylamine N-Oxide （TMAO） and serum amyloid A （SAA） levels in peripheral blood of patients with chronic cerebral hypoperfusion （CCH）. MethodsThe patients attending the Department of Neurology of Sichuan Provincial Peoples Hospital from February 2022 to June 2022 were divided into CCH group （n=55） and control group （n=42） based on the results of magnetic resonance arterial spin labeling （ASL）. The levels of TMAO and SAA were detected by ELISA and their diagnostic value for CCH were anaylzed by ROC curve. ResultsThe levels of TMAO （47.24±8.84 vs 40.81±8.33, t=3.639, P＜0.05） and SAA （14.04±2.70 vs 12.20±2.30, t=3.542, P＜0.05） in CCH group were significantly higher than those in control group. High levels of TMAO and SAA and history of primary hypertension were independent risk factors for the occurrence of CCH （P＜0.05）. The areas under ROC curve （AUC） of TMAO and SAA for diagnosing CCH were 0.701 （95%CI: 0.594-0.809） respectively and 0.675 （95%CI: 0.565-0.786）. The combined detection of TMAO and SAA achieved the highest AUC of 0.765 （95%CI: 0.667-0.863）. ConclusionBoth TMAO and SAA are related to the occurrence of CCH and can be used as auxiliary diagnostic indicators for CCH.