Abstract: Objective To investigate the relationship between the serum protein Z(PZ) level and the polymorphism of the 79 th nucleotide of intron F(FG79 A) gene and acute ischemic stroke(AIS), and provide a reference for in-depth understanding of the pathogenesis, diagnosis and treatment of AIS. Methods Total 87 cases of AIS patients(AIS group) and 87 cases of healthy people(control group) admitted to the Department of Neurology, the Second Affiliated Hospital of Hainan Medical College from May 2017 to December 2019 were selected. The serum PZ level and FG79 A genotype distribution were compared between the two groups. The correlation between the serum PZ and the National Institutes of Health Neurological Defective Score(NIHSS) was analyzed using Pearson. Logistic multiple regression equations were used to analyze the correlation between PZ, FG79 A genotypes, alleles and AIS. The serum PZ levels of two groups of patients with different genotypes was compared. Results The serum PZ of AIS group was(953.07±126.83) μg/L, lower than that of the control group(1 204.52±357.73) μg/L(t=6.179, P<0.001). The serum PZ was negatively correlated with the NIHSS score after onset(r=-0.669, P<0.05). The allele G frequency(52.30%, 91/174) in the AIS group was higher than the control group(35.06%, 61/174), and the allele A frequency(47.70, 83/174) was lower than the control group(64.95%, 113/174, all P<0.05). The PZ, genotype AA and allele A of FG79 A were associated with AIS(all P<0.05). Conclusion The expression of PZ is low in AIS patients, which is related to the degree of neural defects after AIS. FG79 A genotype AA and allele A are related to AIS and can affect PZ expression.