Objective To investigate the correlation between serum apolipoprotein B (ApoB) to apolipoprotein A1 (ApoA1) ratio and the levels of multiple cytokines secreted by CD4+ T lymphocytes and ischemic cerebrovascular disease (ICVD), intracranial atherosclerotic stenosis in patients.Methods This study included 163 ICVD patients undergoing digital subtraction angiography (DSA), including basic clinical data, DSA findings, and serum ApoB, ApoA1, and CD4+ T cytokines (IL-4, IL-6, IL-10, IL-12, IL-21) levels. The studies analyzed the correlation between the ApoB/ApoA1 ratio and CD4+ T cytokine levels and the degree of cerebral artery stenosis, grade of collateral circulatory compensation, mRS score at 3 months of follow-up, and clinical risk factors. Results The study found that serum ApoB/ApoA1 ratio and IL-6 were significantly higher in the stenosis group, while IL-4 and IL-10 levels were significantly lower than the normal group, and ApoB/ApoA1 ratio and IL-6 in patients with the mild stenosis group, and IL-4 and IL-10 were significantly lower than the mild and moderate stenosis group. ApoB/ApoA1 levels were significantly higher than the good prognosis group. Multivariate regression analysis indicated that ApoB/ApoA1 ratio, IL-4, and IL-6 were independent risk factors for intracranial and external intracranial artery stenosis in patients with ICVD. ROC curve analysis showed that the ratio of ApoB/ApoA1, IL-4, IL-6, and (the) three had some predictive value for intracranial atherosclerotic stenosis in ICVD patients, and the combination of the three was better.Conclusion ApoB/ApoA1 ratio, IL-4 and IL-6 levels are closely related to intracranial and extracranial large artery atherosclerotic stenosis in patients with ICVD, which can be used as predictive biomarkers for intracranial and extracranial large artery atherosclerotic stenosis in patients with