Background: The relationship between the imbalance of TH1-TH2 cytokine levels in the early stages of acute ischemic stroke (AIS) and the subsequent development of post-stroke depression (PSD) remains unclear. Early detection of PSD and understanding its progression hold critical clinical significance.

Methods: A prospective cohort study was conducted involving 119 patients with AIS admitted to Suzhou Municipal Hospital. Th1/Th2 cytokines (TNF-α, IL-2, IFN-γ, IL-4, IL-6, IL-10) were measured within 24 h of admission. PSD was assessed at 3 months using the Hamilton Depression Rating Scale (HAMD). Logistic regression analysis was used to identify factors associated with PSD.

Results: The PSD group exhibited higher HAMD scores and modified Rankin Scale (mRS) scores at 3 months (P < 0.001). The Th1 cytokine TNF-α was elevated, while the Th2 cytokine IL-4 was decreased in the PSD group (P < 0.05). The TNF-α/IL-4 ratio was significantly elevated in the PSD group (P < 0.001). Multivariate regression analysis confirmed that Th1-Th2 cytokine imbalance in the early stages of AIS was an independent predictor of PSD at 3 months (P-trend<0.001), with the TNF-α/IL-4 ratio demonstrating the highest predictive value (AUC = 0.741, sensitivity 57.9 %, specificity 85.2 %, P < 0.001).

Conclusion: Early Th1-Th2 cytokine imbalance in AIS patients serves as a significant predictor of PSD at 3 months. These findings suggest that immune dysfunction during the early stage may aid in identifying patients at higher risk for developing PSD.

Keywords: Acute ischemic stroke; Post-stroke depression; Th1-Th2 imbalance.

Copyright © 2025. Published by Elsevier B.V.

背景： 急性缺血性卒中（AIS）早期阶段TH1-TH2细胞因子水平失衡与随后发生的卒中后抑郁（PSD）之间的关系仍不清楚。早期检测PSD及其进展具有重要的临床意义。

方法： 本研究在苏州市立医院进行了一项前瞻性队列研究，涉及119名AIS患者。入院24小时内测量了TH1/TH2细胞因子（TNF-α、IL-2、IFN-γ、IL-4、IL-6、IL-10）。使用汉密尔顿抑郁量表（HAMD）在3个月时评估PSD。采用逻辑回归分析确定与PSD相关的因素。

结果： PSD组的患者在三个月时HAMD评分和改良Rankin量表（mRS）评分较高（P

结论： 在AIS患者中，在早期出现的TH1-TH2细胞因子失衡是PSD的重要预测因素。这些发现表明，早期免疫功能障碍可能有助于识别发生PSD风险较高的患者。

关键词： 急性缺血性卒中；卒中后抑郁；TH1-TH2失衡。