Abstract: OBJECTIVE To observe the association of Helicobacter pylori（Hp） infection, telomerase reverse transcriptase（TERT） gene polymorphism with carotid atherosclerosis（CAS） in patients with cerebral infarction（CI）. METHODS A total of 61 CI patients who were treated in neurology department of Yantai Harbor Hospital from Jan 2017 to May 2021 were recruited as the study objects and were divided into four groups according to carotid intima-media thickness（IMT）: the general group with IMT less than 1.00 mm（16 cases）, the thickening group with IMT no less than 1.00 mm（12 cases）, the stable group with local IMT no less than 1.50 mm, strong echo signal（19 cases）, the unstable group with local IMT no less than 1.50 mm, weak echo signal or mixed type（14 cases）. The prevalence of Hp infection and TERT gene polymorphisms were compared among the four groups, and the association with CAS was analyzed. RESULTS The positive rate of Hp was 25.00% in the general group, 58.33% in the thickening group, 78.95% in the stable group, 78.57% in the unstable group; the positive rate of Hp was higher in the stable group and the unstable group than in the general hospital（P＜0.05）. There were significant differences in the frequencies of TT, TG and GG genotypes at rs2736100 locus of TERT gene among the four groups（P＜0.05）. There were significant differences in the frequencies of GG, GA and AA genotypes at rs2853676 locus of TERT gerne among the four groups（P＜0.05）. In the stable group, the frequency of GA genotype of the Hp-positive patients was higher than that of the Hp-negative patients and the Hp-positive patients in the general group（P＜0.05）. Logistic regression analysis showed that the CIS patients with positive Hp, TG and GG genotypes at rs2736100 locus of TERT gene and GA and AA genotypes at rs2853676 locus were at higher risk of CAS（P＜0.05）. CONCLUSION The CI patients with Hp infection, TG and GG genotypes at TERT gene and GA and AA genotypes at rs2853676 locus are more likely to have CAS.