Abstract:

Objective To explore the correlations between the cerebral infarction area and cytokines and immune status in patients with acute ischemic stroke， and to provide the theoretical basis for immunotherapy of the patients with different degrees of cerebral infarction. Methods Sixty-seven patients with acute ischemic stroke within 72 h of the onset were randomly selected according to the inclusion and exclusion criteria， and were divided into large-area cerebral infarction group （n=34） and non-large-area cerebral infarction group（n=33） on the basis of the biggest infarction area in the sequences of magnetic resonance diffusion-weighted imaging（CDWI）. Clinical baseline characteristics such as gender， age， and medical history were collected from the patients in two groups， the serum levels of interleukin （IL）-2， IL-6， IL-10， and IL-17A， tumor necrosis factor-α （TNF-α）， and interferon-γ （IFN-γ） were measured using flow cytometry； the absolute values of lymphocytes （LYM#）， lymphocyte percentages （LYM%）， and neutrophil/lymphocy ratios（NLR） in peripheral blood of the patients caiculated， and the ratios of IFN-γ/IL-4， TNF-α/IL-4， and TNF-α/IL-10 rations were also calculated. The values of National Institutes of Health Stroke Scale （NIHSS） scores of the patients were evaluatd on the basis of the assessment of clinical neurological signs. The correlations of the cerebral infarction area and NIHSS score， cytokines and immune status groups of the patients in two were tested by rank correlation analysis. Results Compared with non-large-area cerebral infarction group， the serum levels of IL-2， IL-6， IL-10， IL-17A， TNF-α， and IFN-γ as well as the NLR in the peripheral blood of the patients in large-area cerebral infarction group were significantly increased （P<0.01）， while the LYM#， LYM% and TNF-α/IL-4 were significantly decreased （P<0.01）. There was a positive correlation between cerebral infarction area and NIHSS score in the patients in large-area cerebral infarction group （r_s =0.521， P<0.05）， and there was a significantly positive correlation between cerebral infarct area and NIHSS score in the patients in non-large-area cerebral infarction group （r_s =0.721， P<0.001）. The NIHSS scores were positively correlated with serum IL-6 （r_s =0.306， P=0.005）， IL-4 （r_s =0.252， P<0.001）， IL-2 （r_s =0.109， P=0.025）， IL-17A （r_s =0.405， P<0.001）， and IFN-γ （r_s =0.146， P<0.001） levels in two groups； no correlations were found between NIHSS scores and TNF-α （r_s =0.039， P=0.726） and IL-10 （r_s =0.121， P=0.192） levels. NIHSS scores of the patients in two groups had negative correlatious with the serum level of LYM# （r_s =-0.026， P=0.036） and LYM% （r_s =-0.008， P=0.002） ，and had positive correlated with NLR （r_s =0.315， P=0.009）. Conclusion The infarction area of the patients with actue cerebral infarction is correlated with the NIHSS score， the inflammatory response， the degree of adaptive immune injury， and the immune status. The have positive correlation with cytokines and immune markers and the overall size of the infarction area. Compared with the patients with non-large-acea cerebral infarction， the immunosuppression of the patients with large-area infarcted areas is more likely to occure.

Key words: Acute cerebral infarction, Immunity, inflammation, Cytokines, Inflammatory cells, Infarct size, National Institutes of Health Stroke Scale score