| Object:To investigate and analyze the effect of different factors on various cytokines and the immune status of patients with acute ischemic stroke.Methods:Patients with acute ischemic stroke within 72 hours of onset from October 2017 to October 2019 in the Department of Neurology,First Hospital of Jilin University were selected as the research subjects.Serum samples of all patients were collected immediately after admission,and the levels of IL-2,IL-4,IL-6,IL-10,IL-17 A,TNF-? and IFN-? in serum were measured using cytometric bead array.A total of 120 patients were collected in this study.Among them,there were 53 patients of moderate severity with anterior circulation infarction,the NIHSS score was between 4-13 and recorded as group A.The patients' general information,laboratory tests,imaging information,and infection indicators were collected.According to the tertile of homocysteine,Patients in group A were divided into high homocysteine group(Hcy1 group),medium-level homocysteine group(Hcy2 group),and low homocysteine group;according to the history of smoking,patients in group A were divided into smoking group and non-smoking group;according to clinical symptoms,laboratory tests,and imaging information to determine whether the patients were infected and divided into stroke-associated-infection group(SAI group)and non-stroke-associated-infection group(nSAI group).The effects of each factor on the levels of cytokines and immune status indicators IFN-?/IL-4 ratio,TNF-?/IL-4 ratio and TNF-?/IL-10 ratio were analyzed.In addition to group A,a total of 34 patients with severe cerebral infarction were collected,which was the large-area cerebral infarction group,recorded as group B,for anterior circulation infarction,the maximum diameter of infarction hemisphere > 3.0cm,for posterior circulation infarction,the area of infarcted brainstem was> 1/3 of the brainstem area.In addition to group A and group B,a total of 34 patients with non-large area cerebral infarction matched with gender and age in group B were collected and recorded as group C,for anterior circulation infarction,the maximum diameter of infarction hemisphere > 3.0cm,for posterior circulation infarction,the area of infarcted brainstem was> 1/3 of the brainstem area.Compare the absolute value of lymphocytes(LYM #),lymphocyte percentage(LYM%),neutrophil/lymphocyte ratio(NLR),cytokine levels and immune status indicators IFN-? IL-4 ratio,TNF-?/IL-4 ratio,and TNF-?/IL-10 ratio between group B and C,evaluating the effect of infarct size on inflammatory factors and immune status.Results:(1)Compared with the serum IFN-? level [0.31(0.01-0.61)],IL-6 level [2.83(1.82-5.85)],and IL-10 level [0.85(0.34-1.40)] in the Hcy1 group,the serum IFN-? [1.04(0.49-1.99)],IL-6 [9.94(5.31-36.98)],and IL-10 [1.42(1.03-3.84)] in the Hcy3 group were significantly higher in the patients in the group,with corrected P <0.05;The level of IL-2 increased,but there was no significant difference;IL-6 [8.27(4.43-30.38)] in the Hcy2 group was significantly higher than IL-6 [2.83(1.82-5.85)] in the Hcy1 group;There were no significant differences in the remaining cytokine levels.(2)Compared with the serum IL-4 level [0.48(0.23-0.68)] pg / ml in the non-infected group,the serum IL-4 level [0.78(0.58-1.36)] pg / ml in the infected group was significantly higher,P < 0.05,there was no significant difference in the remaining cytokine levels;the IFN-? / IL-4 ratio in the infected group was lower,but it did not reach a statistical difference P = 0.059.(3)Compared with the IFN-? [0.29(0.15-0.62)] pg / ml,IL-10 [1.17(0.68-1.42)] pg /ml,IL-2 [0.40(0.32-0.78)] pg / ml,and IL-6 [3.65(.66-10.13)] pg / ml,the IFN-? [0.80(0.37-1.80)] pg / ml,IL-10 [1.52(1.01-3.48)] pg / ml,IL-2 [0.66(0.44-1.51)] pg / ml and IL-6 [8.68(4.67-28.17)] pg / ml in smoking group increased significantly,P <0.05;there was no significant difference in other cytokines.(4)Compared with LYM # [1.76(1.43-2.35)]^109,LYM% [0.26(0.21-0.33)],and NLR [2.61(1.73-3.36)] in group C,LYM # [1.41(1.05-1.79))]^109,LYM% [0.14(0.08-0.22)] is significantly lower in group B,NLR [5.27(3.26-10.79)] is significantly higher in groupB,P <0.01;the level of each cytokine is higher in group B,P <0.01;the TNF-?/IL-4 ratio in group B [0.69(0.54-0.83)] was significantly lower than that in group C [2.50(1.62-5.99)],P <0.05;the IFN-?/IL-4 ratio and TNF-?/IL-10 ratio in group B has a decreasing trend,but there is no significant difference,P was 0.09 and 0.146,respectively.Conclusions:(1)Different levels of homocysteine can change the immune status of patients with cerebral infarction in the acute phase.High levels of homocysteine can increase the level of pro-inflammatory cytokines in serum;(2)The immune status of patients with cerebral infarction at the acute stage is an important factor affecting the risk of stroke-associated-infection.Patients whose immune status shifts to the anti-inflammatory direction are more likely to develop stroke-associated-infection;(3)Smoking increases the levels of multiple pro-inflammatory cytokines in the serum of patients with cerebral infarction at the acute stage,but due to the interference of gender and the limitation of the number of enrolled patients,the impact of smoking on the immune status needs further investigation;(4)The immune status of patients with cerebral infarction at the acute stage is related to the infarct volume,and patients with large-area cerebral infarction are more likely to develop immunosuppression. |
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