徐 甜¹ 殷小平^1,2*

1.赣南医科大学 2.九江学院附属医院

摘要(Abstract)：

卒中相关性肺炎（stroke-associated pneumonia，SAP）是急性卒中后常见的感染并发症之一，显著增加患者病死率并导致不良预后。长期以来SAP被认为主要与吞咽障碍和误吸有关，但近年研究发现，卒中后免疫功能变化在其发生发展中起重要作用。卒中诱导的免疫抑制综合征（stroke-induced immunosuppression syndrome，SIDS）可导致机体抗感染能力下降，从而增加感染风险。本文综述了SAP的免疫发病机制及相关治疗策略，以期为SAP的早期防治和治疗提供思路和依据。

关键词(KeyWords)：

卒中相关性肺炎；免疫抑制；免疫调节；β受体阻滞剂；肠道菌群

参考文献(References)：

［1］王拥军，陈玉国，吕传柱，等.卒中相关性肺炎诊治中 国专家共识（2019 更新版）［J］.中国卒中杂志，2019，14（12）： 1251-1262.

［2］ELTRINGHAM S A，KILNER K，GEE M，et al. Factors Associated with Risk of Stroke-Associated Pneumonia in Patients with Dysphagia: A Systematic Review ［J］. Dysphagia， 2020， 35 （5）: 735-44. 

［3］PRASS K ， MEISEL C ， HöFLICH C ， et al. Stroke-induced immunodeficiency promotes spontaneous bacterial infections and is mediated by sympathetic activation reversal by poststroke T helper cell type 1-like immunostimulation ［J］. J Exp Med， 2003， 198（5）: 725-36. 

［4］BAI J， ZHAO Y， WANG Z， et al. Stroke-Associated Pneumonia and the Brain-Gut-Lung Axis: A Systematic Literature Review ［J］. Neurologist， 2025， 30（4）: 237-50. 

［5］MCCULLOCH L ， SMITH C J ， MCCOLL B W. Adrenergic-mediated loss of splenic marginal zone B cells contributes to infection susceptibility after stroke［J］. Nat Commun， 2017， 8: 15051. 

［6］ZHONG J，XIONG T，LUO X，et al. Repulsive guidance molecule A in the resolution of inflammation from ischemic stroke-associated pneumonia in mice［J］. Sci Rep，2025，15（1）: 37197. 

［7］WANG H， DENG Q W， PENG A N， et al. β-arrestin2 functions as a key regulator in the sympathetic-triggered immunodepression after stroke ［J］. J Neuroinflammation， 2018， 15（1）: 102. 

［8］COURTIES G， FRODERMANN V， HONOLD L， et al. Glucocorticoids Regulate Bone Marrow B Lymphopoiesis After Stroke ［J］. Circ Res， 2019， 124（9）: 1372-85. 

［9］YI H， HU M， YUAN L， et al. BM-MSC-derived migrasomes reverse stroke-induced thymic atrophy and immunosuppression via Pin1 delivery to thymic epithelial cells ［J］. J Neuroinflammation， 2025， 22（1）: 271. 

［10］NGUYEN D T， MENDOZA K， HALL C， et al. Alpha 7 nicotinic acetylcholine receptor contributes to long-term cognitive recovery following ischemic stroke ［J］. Exp Neurol， 2026， 397: 115562. 

［11］XIA X M， DUAN Y， WANG Y P， et al. Vagus nerve stimulation as a promising neuroprotection for ischemic stroke via α 7nAchR-dependent inactivation of microglial NLRP3 inflammasome ［J］. Acta Pharmacol Sin， 2024， 45（7）: 1349-65. 

［12］TELEC M， FRYDRYCHOWICZ M， KAZMIERSKI R， et al. Circulating CD4+， CD8+， and double-negative T cells in ischemic stroke and stroke-associated infection: a prospective case-control study ［J］. Front Cell Neurosci，2025，19: 1547905. 

［13］YANG M ， LI Y ， SHI K ， et al. Single-Cell Transcriptomes of Immune Cells from Multiple Compartments Redefine the Ontology of Myeloid Subtypes Post-Stroke［J］. Adv Sci （Weinh）， 2025， 12（13）: e2408722. 

［14］BELLAVIA S， SCALA I， RIZZO P A， et al. Th1/Th2 polarization of peripheral immune response in atherothrombotic and cardioembolic stroke: a prospective study ［J］. Sci Rep，2022，12 （1）: 16384. 

［15］WANG R H，WEN W X，JIANG Z P，et al. The clinical value of neutrophil-to-lymphocyte ratio （ NLR ） ， systemic immune-inflammation index （SII）， platelet-to-lymphocyte ratio （PLR） and systemic inflammation response index （SIRI） for predicting the occurrence and severity of pneumonia in patients with intracerebral hemorrhage［J］. Front Immunol，2023，14: 1115031. 

［16］HOFFMANN S ， HARMS H ， ULM L ， et al. Stroke-induced immunodepression and dysphagia independently predict stroke-associated pneumonia - The PREDICT study ［J］. J Cereb Blood Flow Metab， 2017， 37（12）: 3671-82. 

［17］ZHANG C，ZHANG G，YE Z，et al. Feasibility of Serum Peroxiredoxin 2 as a Biochemical Indicator for Reflecting Severity and Prognosticating Stroke-Associated Pneumonia ， Early Neurological Deterioration and Poor Neurological Outcomes in Acute Supratentorial Intracerebral Hemorrhage: An Observational Analytical Clinical Study［J］. Neuropsychiatr Dis Treat，2025，21: 621-40. 

［18］BALLA H Z ， CAO Y ， STRöM J O. Effect of Beta-Blockers on Stroke Outcome: A Meta-Analysis ［J］. Clin Epidemiol， 2021， 13: 225-36. 

［19］GAO F， DU W， GUO C， et al. α7nACh receptor， a promising target to reduce BBB damage by regulating inflammation and autophagy after ischemic stroke ［J］. Biomed Pharmacother， 2024， 179: 117337. 

［20］CORRIERO A， SOLOPERTO R， GIGLIO M， et al. Probiotics to reduce ventilator-associated pneumonia in adults with acute non ‑ anoxic brain injury: Study Protocol for a Double-Blind Multicenter Randomized International Clinical Trial（PROACT）［J］. Trials， 2025， 26（1）: 484. 

［21］CHENG B ， LIU S ， GAO L ， et al. Long-Term Minocycline Treatment Exhibits Enhanced Therapeutic Effects on Ischemic Stroke by Suppressing Inflammatory Phenotype of Microglia Through the EMB/MCT4/STING Pathway ［J］. CNS Neurosci Ther， 2025， 31（3）: e70328. 

［22］BRYANT A E ， STEVENS D L. Investigating the immunomodulatory activities of omadacycline ［J］. J Antimicrob Chemother， 2022， 78（1）: 78-83. 

［23］SANDERS M，BERINGER P. Immunomodulatory activity of omadacycline in vitro and in a murine model of acute lung injury ［J］. mSphere， 2024， 9（11）: e0067124.