Burhanettin ÇİĞDEM, Özlem YILDIZ KAYIM, Mustafa Zahir BAKICI, Suat TOPAKTAŞ

Association of autonomic nervous system functions with immune response and prognosis in acute ischemic stroke patients

Amaç. Serebrovasküler hastalık nöroloji pratiğinde en sık karşılaşılan ve ciddi morbidite vemortaliteye sebep olan bir durumdur. Serebrovasküler hastalıkta otonom fonksiyonlardaetkilenmeyi gösteren kalp hızı değişkenliğinde azalma olduğu bildirilmektedir. Otonom sinirsistemi immun durumun monitörize edilmesinde ve inflamasyonun kontrolünde önemli rol oynar.Benzer şekilde serebrovasküler hastalıkların akut döneminde immün sistemin de etkilendiğinigösteren çalışmalar mevcuttur. Amacımız akut iskemik serebrovasküler hastalıklarda otonom sinirsistemi fonksiyonunun immun yanıt ve prognoza etkisini araştırmaktır. Yöntem. Çalışmaya ortaserebral arter infarktı olan 44 hasta ve 44 sağlıklı birey alınmıştır. Otonom sinir sistemi frekansadayalı kalp hızı değişkenliği analiz yöntemiyle değerlendirilmiştir. İmmün sistem etkilenmesinideğerlendirmede 1, 3, 7 ve 10. günlerde ELİSA yöntemiyle serum interlökin-1β, interlökin-6,tümör nekrozis faktör α ve interlökin-10 düzeyleri çalışıldı. Prognoz 3 ay sonra Rankin skoru iledeğerlendirildi. Bulgular. Hastalarda kontrollerle karşılaştırıldığında Düşük Frekanslı GüçNormalize Ünit (LFnü) yüksek, Yüksek Frekanslı Güç Normalize Ünit (HFnü) düşük veLFnü/HFnü oranı ise yüksek bulundu. Sol orta serebral arter infaktlarında daha belirgin olmaküzere tüm hastalarda 10. günde İnterlökin-6 seviyesinde artış, İnterlökin-10 seviyesinde isebaşlangıçtan itibaren tüm günlerde düşüş görüldü. İnterlökin-1β ve tümör nekrozis faktör αseviyeleri sol orta serebral arter infaktlarında daha belirgin olmak üzere tüm hastalarda düşüktü.Rankin skorları arasında farklılık bulunmadı. Sonuç. İskemik serebrovasküler hastalık immünsistem etkilenmesi ile birliktedir. Özellikle orta serebral arter infaktlarında ortaya çıkan bubozulmuş immun yanıt, azalmış parasempatik aktivite yanında artmış sempatik aktiviteyleilişkilendirilebilir.

Akut iskemik inmeli hastalarda otonom sinir sistemi f onksiyonlarının immun yanıt ve p rognoz ile ilişkisi

Aim. Cerebrovascular disease is the most commonly encountered condition which causes seriousmortality and morbidity in neurological practice. It has been reported that heart rate variabilitydeclines in a cerebrovasculer disease, which shows that autonomic functions are affected.Autonomic nervous system has a significant role in monitoring immune status and controllinginflammation. Similarly, there are studies reporting that immune system is affected during acutephase of cerebrovascular diseases. In the present study, our aim was to investigate the effect ofautonomic nervous system on immune response and prognosis in acute ischemic cerebrovasculardiseases. Method. 44 patients with middle cerebral artery infarction and 44 healthy controls wereincluded in this study. Autonomic nervous system was evaluated using a methodology analysingthe heart rate variability based on frequency. In order to evaluate the effects on immun system,serum levels of interleukin 1β, interleukin 6, tumor necrosis factor alfa and interleukin 10 weremeasured on the 1st, 3rd, 7thand 10thday by ELISA. Prognosis was evaluated by Rankin scale after3 months. Results. Compared to the controls, low frequency power in normalized units (LFnu)was found to be high, high frequency power in normalized units (HFnu) was found to be low andratio of LFnu/HFnu was found to be high in the patients group. The increase being more marked inleft middle cerebral artery infarctions, interleukin-6 level were increased on the 10thday andinterleukin-10 level was decreased at all days compared to baseline in all patients. Interleukin-1βand tumor necrosis factor α levels were lower in all patients but the decrease was more pronouncedin patients having left middle cerebral artery infarction. There was no difference between theRankin scores of the patients having right and left middle cerebral artery infarction. Conclusions.Ischemic cerebrovascular disease is associated with an effect on immune system. This impairedimmun response can be correlated both with a decreased parasympathetic activity and an increasedsympathetic activity particularly in patients with middle cerebral artery infarctions.

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