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Objective To explore the expression of CD4+ effector memory T cells (CD4+ TEM) in peripheral blood of acute ischemic stroke patients with pulmonary infection, and to analyze the value of CD4+ TEM combined with interleukin⁃6 (IL⁃6) and hypersensitive C⁃reactive protein (hs⁃CRP) in the diagnosis of pulmonary infection in patients with acute ischemic stroke. Methods Totally 54 confirmed acute ischemic stroke patients with pulmonary infection who were treated in the Department of Neurology at The Affiliated Hospital of Xuzhou Medical University from June 2018 to December 2019 were chosen as the infection group, meanwhile, 55 acute ischemic stroke patients without pulmonary infection were assigned as the control group. The clinical characters and the expression levels of CD4+ TEM cells were compared in the 2 groups. Univariate and multivariate Logistic regression analysis were used to screen the risk factors of pulmonary infection in patients with acute ischemic stroke, and receiver operating characteristic (ROC) curve was further conducted to evaluate the diagnostic value of the percentage of CD4+ TEM, IL⁃6, hs⁃CRP and combined detection in pulmonary infection patients with acute ischemic stroke. Results Multivariate Logistic regression analysis showed that the increased percentage of CD4+ TEM cells (OR=1.153, 95%CI:1.069-1.244; P=0.000), IL⁃6 (OR=1.351, 95%CI:1.046-1.747; P=0.021) and hs⁃CRP (OR=1.087, 95%CI:1.008-1.172; P=0.021) were important risk factors for pulmonary infection with acute ischemic stroke. When the percentage of CD4+ TEM cells, IL⁃6 and hs⁃CRP were used as predictors of pulmonary infection with acute ischemic stroke alone, the area under the ROC curve were 0.906 (95%CI:0.850⁃0.961), 0.799 (95%CI:0.714-0.885) and 0.831 (95%CI:0.754-0.908) respectively. When the percentage of CD4+ TEM cells were combined with IL⁃6 and hs⁃CRP, the area under the curve increased to 0.943 (95%CI:0.904-0.982). Conclusions The percentage of CD4+ TEM cells combined with IL⁃6 and hs⁃CRP has better diagnostic value for pulmonary infection with acute ischemic stroke, and can be used as biomarkers for early prediction of pulmonary infection with acute ischemic stroke. doi:10.3969/j.issn.1672⁃6731.2021.04.013