急性缺血性卒中患者血清中细胞因子水平和免疫状态变化及危险因素分析

doi:10.13481/j.1671-587X.20260222

Abstract

Abstract:

Objective To discuss the levels of cytokines and the immune status in the serum of patients with acute ischemic stroke （AIS）， and to clarify the effects of factors such as homocysteine （Hcy） level， post-stroke infection， and smoking on the immune response in AIS patients. Methods A total of 53 AIS patients were selected. Basic information of the patients was collected， and serum samples were collected within 72 h of onset. The levels of various cytokines in the serum of the patients were measured， including Hcy， interleukin （IL）-2， IL-4， IL-6， IL-10， IL-17A， interferon-γ （IFN-γ）， and tumor necrosis factor-α （TNF-α）. The patients were grouped according to the tertiles of Hcy level， the occurrence of post-stroke infection， and smoking status， respectively. The differences in baseline data and the levels of the above cytokines were compared among the patients in various groups； multiple linear regression models were used to analyze the correlations between the levels of various cytokines and Hcy level， smoking status， and other baseline indicators in AIS patients. Results Compared with low Hcy level group， the serum levels of IL-6 and IFN-γ in the patients in high Hcy level group were significantly increased （P<0.05）. Multiple linear regression analysis showed an association between Hcy level and IFN-γ level （β=0.363， P<0.05）. Compared with non-infection group， the serum level of IL-4 in the patients in infection group was significantly increased （P<0.01）， while the IFN-γ/IL-4 ratio in serum of the patients showed a decreasing trend， but the difference was not statistically significant （P>0.05）. Compared with non-smoking group， the serum levels of IL-2， IL-6， IL-10， and IFN-γ in the patients in smoking group were significantly increased （P<0.05）. Conclusion In AIS patients， high Hcy level and smoking are associated with increased levels of multiple pro-inflammatory cytokines in the serum of the patients， and the occurrence of post-stroke infection is associated with increased levels of anti-inflammatory cytokines in the serum of the patients.

Key words: Acute ischemic stroke, Cytokine, Immune balance, Homocysteine, Smoking, Post-stroke infection

CLC Number:

R743.3

Jiulin YOU,Liangshu FENG,Xin LI,Xinyu WANG,Shuang WANG,Mingqin ZHU,Lingmin ZHAO,Xingqi SU,Jing WANG,Jiachun FENG,Chuan WANG,Di MA. Changes in serum cytokine levels, immune status and risk factor analysis in patients with acute ischemic stroke[J].Journal of Jilin University(Medicine Edition), 2026, 52(2): 499-506.

Figures/Tables 6

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References 25

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Data	Low level of Hcy group （n=17）	Medium level of Hcy group（n=18）	High level of Hcy group（n=18）	χ²/Z	P
Gender [n(%)]
Female	4（23.5）	6（33.3）	5（31.6）	0.42	0.81
Male	13（76.5）	12（66.7）	13（68.4）	0.42	0.81
Age [M(P25,P75), year]	59（39,67）	59（35,78）	61（36,78）	0.71	0.70
NIHSS score [M(P25,P75)]	7（4,11）	9（4,11）	7.5（5,11）	0.10	0.95
Smoking [n(%)]	8（47.1）	13（72.2）	10（55.6）	2.38	0.31
Hypertension [n(%)]	10（55.6）	10（55.6）	12（66.7）	0.49	0.79
Diabetes [n(%)]	6（33.3）	4（22.2）	6（33.3）	0.84	0.66
LDL-C [M(P25,P75), mmol·L^-1]	3.1(2.4,3.5)	2.7(2.0,3.6)	3.1(2.4,3.5)	0.63	0.73
UA[M(P25,P75), μmol·L^-1]	310(238,399)	325(206,657)	310(195,442)	0.54	0.76

Group	IL-2[ρ_B/(ng·L^-1)]	IL-6[ρ_B/(ng·L^-1)]	IL-10[ρ_B/(ng·L^-1)]	IFN-γ[ρ_B/(ng·L^-1)]	IL-4 [ρ_B/(ng·L^-1)]	IL-17A[ρ_B/(ng·L^-1)]	TNF-α[ρ_B/(ng·L^-1)]	IFN-γ/IL-4
Low level of Hcy (n=17)	0.63(0.35，0.75)	2.82(1.83，5.92)	0.87(0.38，1.42)	0.31(0.01，0.64)	0.46(0.19，0.82)	3.88(1.23，4.15)	1.48(0.38，1.42)	0.63(0.07，1.51)
Medium level of Hcy (n=18)	0.57(0.38，1.08)	8.27(4.43，30.34) ^*	1.29(0.78，2.65)	0.52(0.18，1.14)	0.59(0.30，0.76)	2.83(1.42，4.67)	1.41(0.54，3.63)	1.07(0.32，2.10)
High level of Hcy (n=18)	0.63(0.36，1.89)	9.90(5.25，37.04) ^*	1.40(1.00，3.31)	0.98(0.52，1.96) ^*	0.65(0.42，1.05)	3.09(1.08，4.90)	1.65(0.43，2.63)	1.20(0.28，3.56)
H	1.178	7.406	4.512	6.336	2.861	0.151	0.139	1.390
P	0.555	0.013	0.105	0.042	0.239	0.927	0.933	0.499

Data	Non-infection group（n=31）	Infection group（n=15）	χ²/Z	P
Gender [n(%)]
Female	9（29.0）	2（13.3）	2.23	0.24
Male	22（71.0）	13（86.7）	2.23	0.24
Age [M(P25,P75), year]	61（54,63）	52（48,65）	0.66	0.51
NIHSS score [M(P25,P75)]	8.0（5.0,10.3）	10.0（7.0,11.0）	-0.83	0.40
Smoking [n(%)]	17（54.8）	11（73.3）	0.94	0.23
Hypertension [n(%)]	16（51.6）	12（80.0）	2.75	0.06
Diabetes [n(%)]	6（19.4）	6（40.0）	1.45	0.14
Hcy [M(P25,P75), mmol·L^-1]	13.0(10.7,19.2)	15.7(11.4,20.8)	-1.11	0.27
LDL-C [M(P25,P75), mmol·L^-1]	3.1(2.4,3.6)	2.6(2.1,2.8)	1.45	0.15
UA [M(P25,P75), μmol·L^-1]	321(293,376)	349（277,364）	-0.08	0.93

Group	IL-2[ρ_B/(ng·L^-1)]	IL-6[ρ_B/(ng·L^-1)]	IL-10[ρ_B/(ng·L^-1)]	IFN-γ[ρ_B/(ng·L^-1)]	IL-4 [ρ_B/(ng·L^-1)]	IL-17A[ρ_B/(ng·L^-1)]	TNF-α[ρ_B/(ng·L^-1)]	IFN-γ/IL-4
Non-infection (n=31)	0.46(0.35,0.79)	5.86(2.05,19.24)	1.23(0.74,1.59)	0.62(0.19,1.12)	0.48(0.23,0.68)	3.15(1.42,4.24)	0.98(0.49,2.20)	1.25(0.64,3.87)
Infection (n=15)	1.00(0.37,4.55)	7.55(4.77,25.34)	1.31(0.83,3.84)	0.59(0.18,1.80)	0.78(0.58,1.36)	3.25(1.78,6.37)	1.82(0.64,2.72)	0.90(0.18,1.71)
Z	-1.828	-0.867	-1.266	-0.375	-3.202	-1.184	-1.008	1.886
P	0.068	0.386	0.206	0.708	0.001	0.237	0.313	0.059

Data	Non-smoking group (n=20)	Smoking group (n=26)	χ²/Z	P
Gender [n(%)]
Female	10（50.0）	4（15.4）	6.40	0.01
Male	10（50.0）	22（84.6）	6.40	0.01
Age [M(P25,P75), year]	59.0（43.5,64.8）	60.5（53.5,65.0）	-0.62	0.54
NIHSS score [M(P25,P75)]	8.0（6.0,10.0）	10.0（6.5,11.0）	-1.40	0.14
Diabetes [n(%)]	8（40.0）	4（15.4）	3.55	0.06
Hypertension [n(%)]	15（75.0）	14（53.9）	2.17	0.14
Hcy [M(P25,P75), mmol·L^-1]	12.45(10.30,21.20)	15.45(11.20,19.70)	-0.62	0.54
LDL-C [M(P25,P75), mmol·L^-1]	2.97(2.41,3.58)	2.89(2.17,3.26)	0.81	0.53
UA [M(P25,P75), μmol·L^-1]	321.0(278.5,365.5)	331.0(263.8,366.8)	-0.06	0.95

Changes in serum cytokine levels, immune status and risk factor analysis in patients with acute ischemic stroke

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Group	IL-2[ρ_B/(ng·L^-1)]	IL-6[ρ_B/(ng·L^-1)]	IL-10[ρ_B/(ng·L^-1)]	IFN-γ[ρ_B/(ng·L^-1)]	IL-4 [ρ_B/(ng·L^-1)]	IL-17A[ρ_B/(ng·L^-1)]	TNF-α[ρ_B/(ng·L^-1)]	IFN-γ/IL-4
Non-smoking (n=20)	0.40 （0.32,0.78）	3.65 （1.66,10.10）	1.17 （0.68,1.42）	0.29 （0.15,0.62）	0.60 （0.39,1.05）	3.93 （1.00,4.80）	1.64 （0.43,2.63）	0.68 (0.38,1.20)
Smoking (n=26)	0.66 （0.44,1.51）	8.68 （4.67,28.17）	1.52 （1.01,3.48）	0.80 （0.37,1.80）	0.57 （0.24,0.82）	3.06 （1.54,5.27）	1.01 （0.51,2.38）	1.33 (0.18,2.52)
Z	-1.995	-2.149	-2.117	-2.087	-1.131	-1.220	-0.687	-1.147
P	0.046	0.032	0.034	0.037	0.258	0.903	0.492	0.251

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