Immunological and autonomic profile of ischemic stroke in lowlands

Objective: Ischemic stroke (IS) accounts for 80-92% of all stroke cases and is primarily associated with cardiovascular diseases and chronic cerebral ischemia.Stroke severity is influenced not only by the localization and volume of the ischemic focus but also by the degree of autonomic-vascular and neuroinflammatory changes.Investigating the relationship between immune and autonomic system parameters in IS, particularly concerning disease severity, remains a crucial area of research.Research objective was to study immunological and autonomic parameters in patients with primary IS of varying severity in low-mountain conditions and clarify the pathogenesis and mechanisms underlying stroke severity.Methods: An observational cohort study was conducted involving 52 patients with primary IS divided into three groups: mild stroke (n = 12), moderate stroke (n = 28), and severe stroke (n = 12).In the acute phase, 44 survivors were observed, of whom 2 (4.5%) had severe neurological deficits, 26 (59%) -moderate deficits, and 16 (36.4%)-mild deficits.Additionally, 8 deceased patients were analyzed separately.Stroke severity was assessed using the Gusev and Skvortsova scale and the NIH Stroke Scale (NIHSS).Heart rate variability (HRV) and immunological parameters, including lymphocyte subpopulations and cytokine profiles, were evaluated on the 1st and 10th days of illness.Results: In the acutest period, mild stroke was characterized by balanced autonomic activity, with neurohumoral activity at 30.1 (8.0)%, decreasing slightly in the acute period to 27.7 (8.6)%.Moderate stroke showed incre ased sympathetic activation, with neurohumoral activity reaching 61.6 (11.0)% and 83.7(8.0)% in the acute period (p< 0.05).Severe stroke demonstrated parasympathetic predominance and reduced immune activity, with levels of complement (CD) CD3+, CD16+, CD19+, and interleukin 1 being 1.4-2 times lower than in moderate stroke and 1.5-3 times lower than in mild stroke (p<0.05).Correlation analysis revealed that in mild stroke, 24% of studied parameters showed significant correlations, which was 5 times higher than in moderate and severe stroke.Among the 8 patients with fatal stroke, the number of significant correlations doubled compared to mild stroke, reaching 59.2%. Conclusion:The interaction between the immune and autonomic systems in IS depends on dis ease severity.Severe stroke is associated with diminished sympathetic regulation and reduced immune activation, while mild stroke demonstrates greater reciprocity between autonomic and immune parameters.These findings contribute to understanding the pathogenesis of ischemic stroke and offer insights for tailored therapeutic strategies.The study provides new insights into the interplay between immune and autonomic systems in IS, enriching knowledge of disease pathogenesis and progression.The results of this study can enhance the treatment of IS patients by incorporating HRV and immunological assessments into clinical practice.These methodologies are already implemented at the Angioneurology Department, City Clinical Hospital No. 1, Bishkek.