Aslı BOLAYIR, Hesna BEKTAŞ, Zeynep ISSI, Fatma Ayşen EREN, Selvi OKUNDU

The relationship of intrathecal immunoglobulin levels with clinic symptoms and prognosis for acute phase ischemic stroke patients

Amaç. İskemik inme, dünya genelinde mortalitenin 3. en sık nedeni olan inmenin, yaklaşık %80- 85ini oluşturur. İskemiye bağlı olarak nöronlarda yıkım meydana gelir, kan beyin bariyeri(KBB)bozulur ve inflamasyon tetiklenir. İskemik inmede hücresel immün yanıtın rolü öncekiçalışmalarda gösterilmiş olup humoral immun yanıtla ilgili oldukça sınırlı sayıda veri mevcuttur.Bu çalışmayla iskemik inmeli hastalarda humoral immun cevabın sonucu olarak intratekalsentezlenen immunglobulinlerin varlığını ve miktarını saptamayı amaçlıyoruz. Böylece, iskemikinmenin uzun dönem prognozu üzerinde humoral immun cevabın etkisinin varlığına ışıktutabiliriz. Yöntem. Bu çalışmaya, 32 ilk ve 19 tekrarlayan iskemik inme atağı geçiren veşikayetlerinin başladığı andan itibaren ilk 72 saat içinde lomber ponksiyonla beyin omurilik sıvısı(BOS) örneği alınan toplam 51 hasta dahil edildi. Alınan BOS örneklerinden hücre sayısı, Ig G, M,A ve mikroalbumin düzeyleri, eş zamanlı alınan serumdan ise Ig G,M,A ve albumin düzeyleriölçüldü. Albumin ve Ig G indeksi ile BOS Ig G/BOS albumin oranları hesaplandı. Hastalarınçekilen bilgisayarlı beyin tomografisi (BBT) ve/veya difüzyon ağırlıklı manyetik rezonansgörüntülemelerinden (DA MRG) infarkt hacmi hesaplandı. Hastalara servise yatışında Glaskowkoma skalası (GKS), National İnstitutes of Health Stroke Scale (NIHSS); taburcu olurken iseNIHSS, modifiye Rankin skalası (MRS) ve Barthel indeksi (BI) skalası uygulandı. Bulgular.Albumin indeksi; ilk iskemik inmesini geçiren hastalarda normalken tekrarlayan iskemik inmesinigeçiren grupta hafif yükselmiş olarak saptandı. BOS Ig G/BOS albumin oranı (0,32 ±0,04) ileBOS Ig G indeksi(1,13 ±0,16) ve BOS Ig G düzeyleri; tekrarlayan iskemik inme geçirenhastalarda ilk iskemik inmesini geçiren gruptakine kıyasla yüksek bulundu. Ayrıca ilk iskemikinme grubunun aksine tekrarlayan iskemik inme geçiren grupta lezyon volümü ile BOS Ig Gdüzeyleri arasında pozitif yönde anlamlı bir ilişki izlendi (p

Akut dönem iskemik inmeli hastalarda intratekal immunglobulin düzeyinin klinik bulgular ve p rognozla ilişkisi

Aim. Ischemic strokes are about 80-85% of the strokes, third common cause of mortality in theworld. Due to ischemia, neurons are damaged, blood brain barrier (BBB) is disrupted andinflammation is triggered. Although the cell mediated immun response in ischemic stroke has beenshowed by previous studies,there is no excessive database is available for humoral immunresponse. In this study, we aim to determine presence and amount of intrathecal immunglobulinsafter ischemic strokes as a result of humoral immun response in patients with the first andrecurrent ischemic stroke. Thus,we could elucidate the presence of humoral immune responseeffect in long-term prognosis of ischemic stroke. Methods. In this study, 51 patient were included.32 patients had first and 19 patients had recurrent ischemic stroke. Cerebrospinal fluid (CSF)samples were taken within 72 hours from the symptoms onset by lomber punction. Cell count,CSF Ig G, M, A and microalbumin levels were assessed in CSF samples, also serum Ig G, M, Aand albumin levels were measured simultaneously. Albumin and Ig G index and CSF Ig G/CSFalbumin ratios were calculated. Infarct volumes of the patients were calculated from computedcranial tomography (CCT) and/or magnetic resonance diffusion weighted imaging (DW MRI).Glasgow Coma Scale (GCS) and National İnstitutes of Health Stroke Scale (NIHSS) were used atthe admission, modified Rankin Scale (MRS),Barthel index (BI) and NIHSS were used at the timeof discharge from the hospital. Results. Albumin index was normal in the patients with their firstischemic stroke but slightly elevated in the recurrent ischemic stroke group. The CSF Ig G levels(p

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