Early Th1-Th2 cytokine imbalance as a predictor for post-stroke depression at 3 months

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.

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.

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).

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.