Association of post-stroke peripheral immune status with prognosis in young and middle-aged patients with acute ischemic stroke

Wu Chunyan; Xu Yajuan

doi:10.13406/j.cnki.cyxb.004184

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Association of post-stroke peripheral immune status with prognosis in young and middle-aged patients with acute ischemic stroke

Frontiers in brain science and neuropsychiatric disorders | 更新时间：2026-10-26

- Association of post-stroke peripheral immune status with prognosis in young and middle-aged patients with acute ischemic stroke
- Journal of Chongqing Medical University Vol. 51, Issue 10, Pages: 1428-1433(2026)
- 作者机构：
  
  吉林大学第一医院神经内科，长春 130021
- 作者简介：
- 基金信息：
- DOI：10.13406/j.cnki.cyxb.004184
  CLC： R743.3
- Received：01 April 2026，
  
  Revised：2026-06-19，
  
  Accepted：22 June 2026，
  
  Published：28 October 2026
- 稿件说明：
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吴春艳，徐亚娟.卒中后外周免疫状态与中青年急性缺血性卒中患者预后的相关性[J].重庆医科大学学报，2026，51（10）：1428-1433.

Wu Chunyan,Xu Yajuan.Association of post-stroke peripheral immune status with prognosis in young and middle-aged patients with acute ischemic stroke[J].Journal of Chongqing Medical University,2026,51(10):1428-1433.
吴春艳，徐亚娟.卒中后外周免疫状态与中青年急性缺血性卒中患者预后的相关性[J].重庆医科大学学报，2026，51（10）：1428-1433. DOI： 10.13406/j.cnki.cyxb.004184.

Wu Chunyan,Xu Yajuan.Association of post-stroke peripheral immune status with prognosis in young and middle-aged patients with acute ischemic stroke[J].Journal of Chongqing Medical University,2026,51(10):1428-1433. DOI： 10.13406/j.cnki.cyxb.004184.

摘要

目的

探讨中青年急性缺血性卒中患者外周免疫状态与临床预后的相关性。

方法

吉林大学第一医院纳入符合标准发病3 d内的急性缺血性卒中患者。采集外周血，采用流式细胞术测定淋巴细胞亚群计数，包括T细胞（CD3

CD19

）、CD4

T细胞（CD3

CD4

）、CD8

T细胞（CD3

CD8

）、B细胞（CD3

CD19

）和自然杀伤细胞（natural killer cell，NK cell）（CD3

CD16

CD56

），用以评估卒中后外周免疫状态。所有患者于发病后90 d进行电话随访，记录改良Rankin评分，0~1分定义为良好预后，2~6分定义为不良预后。

结果

研究最终共纳入223例患者，良好预后组171例，不良预后组52例。良好预后组患者外周血总T细胞计数、CD4

T细胞计数、CD8

T细胞计数显著高于不良预后组。多因素回归分析发现外周血总T细胞计数［比值比（odds ratio，OR）=1.199，95%CI=1.074~1.338，

=0.001］、CD4

T细胞计数（

=1.277，95%CI=1.085~1.503，

=0.003）与3个月良好预后独立相关。总T细胞计数每微升增加100个细胞，获得良好预后的可能性增加19.9%，CD4

T细胞计数每微升增加100个细胞，获得良好预后的可能性增加27.7%。此外，在由传统指标组成的临床预测模型基础上增加总T细胞计数后，净重新分类指数和综合判别改善指数显著改善，AUC有所提高但差异无统计学意义。

结论

卒中后以总T和CD4

T计数为代表的外周免疫状态是中青年急性缺血性卒中患者预后的独立影响因素，综合考虑外周免疫状态能够提高临床预后预测的准确性。

Abstract

Objective

To explore the association between peripheral immune status and clinical prognosis after acute ischemic stroke in young and middle-aged patients.

Methods

Eligible patients with acute ischemic stroke within 3 days of onset were recruited at The First Hospital of Jilin University. Peripheral blood lymphocyte subsets were counted using flow cytometry to evaluate peripheral

immune status after stroke，including T cells（CD3

CD19

），CD4

T cells（CD3

CD4

），CD8

T cells（CD3

CD8

），B cells（CD3

CD19

），and natural killer cells（CD3

CD16

CD56

）. All patients were followed up by telephone at 90 days after stroke onset. The modified Rankin Scale was recorded. A score of 0-1 was defined as a favorable prognosis，while a score of 2-6 was defined as an unfavorable prognosis.

Results

A total of 223 patients were included，of whom 171 had favorable prognosis，and 52 had unfavorable prognosis. Patients with favorable prognosis had significantly higher levels of T cells，CD4

T cells，and CD8

T cells. Multivariate regression analysis revealed that the total T cell count（odds ratio，1.199［1.074-1.338］，

=0.001） and CD4

T cell count（odds ratio，1.277［1.085-1.503］，

=0.003） were independently associated with a favorable prognosis at 3 months. For every increase of 100 cells per microliter in the total T cell count，the probability of a favorable prognosis increased by 19.9%； for every increase of 100 cells per microliter in the CD4

T cell count，the probability increased by 27.7%. Moreover，adding the total T cell count to the clinical predictive model composed of traditional indicators significantly improved the net reclassification improvement and integrated discrimination improvement，and the AUC increased，but the difference was not statistically significant.

Conclusion

The peripheral immune status as indicated by total T cell and CD4

T cell counts after stroke is an independent predictor of prognosis in young and middle-aged patients with acute ischemic stroke. Comprehensive consideration of peripheral immune status can improve the accuracy of clinical prognosis prediction.

关键词

Keywords

references

Capirossi C ， Laiso A ， Renieri L ， et al . Epidemiology，organization，diagnosis and treatment of acute ischemic stroke [J ] . Eur J Radiol Open ， 2023 ， 11 ： 100527 .

Ma ZX ， He WK ， Zhou YX ， et al . Global burden of stroke in adolescents and young adults（aged 15-39 years） from 1990 to 2019：a comprehensive trend analysis based on the global burden of disease study 2019 [J ] . BMC Public Health ， 2024 ， 24 （ 1 ）： 2042 ．

Béjot Y ， Bailly H ， Durier J ， et al . Epidemiology of stroke in Europe and trends for the 21st century [J ] . La Presse Médicale ， 2016 ， 45 （ 12 ）： e391 - e398 ．

GBD 2019 Stroke Collaborators . Stroke. Global，regional，and national burden of stroke and its risk factors，1990-2019：a systematic analysis for the Global Burden of Disease Study 2019 [J ] . Lancet Neurol ， 2021 ， 20 （ 10 ）： 795 - 820 .

Wu XJ ， Ke K ， Liu H ， et al . Social isolation in the young and middle-aged patients with stroke：role of social support，family resilience and hope [J ] . Front Psychiatry ， 2025 ， 16 ： 1499186 ．

万晨蕾，任彬彬 . 基于NLRP3-GSDMD通路的细胞焦亡调控与缺血性脑卒中的免疫治疗策略 [J ] . 中山大学学报（医学科学版）， 2026 ， 47 （ 2 ）： 216 - 226 ．

Wan CL ， Ren BB . Regulation of pyroptosis via the NLRP3-GSDMD pathway and its immunotherapeutic strategy in ischemic stroke [J ] . J Sun Yat Sen Univ Med Sci ， 2026 ， 47 （ 2 ）： 216 - 226 ．

Faura J ， Bustamante A ， Miró-Mur F ， et al . Stroke-induced immunosuppression：implications for the prevention and prediction of post-stroke infections [J ] . J Neuroinflammation ， 2021 ， 18 （ 1 ）： 127 ．

Wu F ， Liu ZC ， Zhou LH ， et al . Systemic immune responses after ischemic stroke：From the center to the periphery [J ] . Front Immunol ， 2022 ， 13 ： 911661 ．

Shi LG ， Sun ZY ， Su W ， et al . Treg cell-derived osteopontin promotes microglia-mediated white matter repair after ischemic stroke [J ] . Immunity ， 2021 ， 54 （ 7 ）： 1527 - 1542 .

Wang H ， Wang Z ， Wu QQ ， et al . Regulatory T cells in ischemic stroke [J ] . CNS Neurosci Ther ， 2021 ， 27 （ 6 ）： 643 - 651 ．

Wang HY ， Ye JR ， Cui LY ， et al . Regulatory T cells in ischemic stroke [J ] . Acta Pharmacol Sin ， 2022 ， 43 （ 1 ）： 1 - 9 ．

Gallizioli M ， Arbaizar-Rovirosa M ， Brea D ， et al . Differences in the post-stroke innate immune response between young and old [J ] . Semin Immunopathol ， 2023 ， 45 （ 3 ）： 367 - 376 ．

Hang H ， Xu C ， Wang L ， et al . Targeting PD-L1 for Ischemic Stroke Recovery：Age-Dependent Modulation of Immune and BBB Pathways [J ] . CNS Neurosci Ther ， 2025 ， 31 （ 7 ）： e70523 .

Jr Adams HP ， Bendixen BH ， Kappelle LJ ， et al . Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment [J ] . Stroke ， 1993 ， 24 （ 1 ）： 35 - 41 ．

Banks JL ， Marotta CA . Outcomes validity and reliability of the modified rankin scale：implications for stroke clinical trials：a literature review and synthesis [J ] . Stroke ， 2007 ， 38 （ 3 ）： 1091 - 1096 ．

DeLong ER ， DeLong DM ， Clarke-Pearson DL . Comparing the areas under two or more correlated receiver operating characteristic curves：a nonparametric approach [J ] . Biometrics ， 1988 ， 44 （ 3 ）： 837 - 845 .

Dorrance AM ， Fink G . Effects of stroke on the autonomic nervous system [J ] . Compr Physiol ， 2015 ， 5 （ 3 ）： 1241 - 1263 ．

Zera KA ， Buckwalter MS . The local and peripheral immune responses to stroke：implications for therapeutic development [J ] . Neurotherapeutics ， 2020 ， 17 （ 2 ）： 414 - 435 ．

Ajmo CT ， Collier LA ， Leonardo CC ， et al . Blockade of adrenoreceptors inhibits the splenic response to stroke [J ] . Exp Neurol ， 2009 ， 218 （ 1 ）： 47 - 55 ．

Shi KB ， Wood K ， Shi FD ， et al . Stroke-induced immunosuppression and poststroke infection [J ] . Stroke Vasc Neurol ， 2018 ， 3 （ 1 ）： 34 - 41 .

Hug A ， Dalpke A ， Wieczorek N ， et al . Infarct volume is a major determiner of post-stroke immune cell function and susceptibility to infection [J ] . Stroke ， 2009 ， 40 （ 10 ）： 3226 - 3232 ．

Goyani P ， Christodoulou R ， Vassiliou E . Immunosenescence：Aging and Immune System Decline [J ] . Vaccines（Basel）， 2024 ， 12 （ 12 ）： 1314 .

Alsbrook DL ， Di Napoli M ， Bhatia K ， et al . Neuroinflammation in acute ischemic and hemorrhagic stroke [J ] . Curr Neurol Neurosci Rep ， 2023 ， 23 （ 8 ）： 407 - 431 ．

Salas-Perdomo A ， Miró-Mur F ， Urra X ， et al . T cells prevent hemorrhagic transformation in ischemic stroke by P-selectin binding [J ] . Arterioscler Thromb Vasc Biol ， 2018 ， 38 （ 8 ）： 1761 - 1771 ．

Iadecola C ， Anrather J . The immunology of stroke：from mechanisms to translation [J ] . Nat Med ， 2011 ， 17 （ 7 ）： 796 - 808 ．

Jain RW ， Yong VW . B cells in central nervous system disease：diversity，locations and pathophysiology [J ] . Nat Rev Immunol ， 2022 ， 22 （ 8 ）： 513 - 524 ．

Ren XF ， Akiyoshi K ， Dziennis S ， et al . Regulatory B cells limit CNS inflammation and neurologic deficits in murine experimental stroke [J ] . J Neurosci ， 2011 ， 31 （ 23 ）： 8556 - 8563 ．

Robertson MJ ， Ritz J . Biology and clinical relevance of human natural killer cells [J ] . Blood ， 1990 ， 76 （ 12 ）： 2421 - 2438 ．

Chen C ， Ai QD ， Chu SF ， et al . NK cells in cerebral ischemia [J ] . Biomed Pharmacother ， 2019 ， 109 ： 547 - 554 ．

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