etkilenmesi ve/veya beyni ilgilendiren bir ya da daha fazla kan damarlarının primer patolojisi olarak tanımlanır. Tüm inmeler içinde beyin infarktı % 70-80, İntra-Serebral Kanama (İSK) % 7-15 ve Subaraknoid Kanama(SAK) ise % 2-8 oranında görülür. İnme sadece gelişmiş ülkelerde değil, tüm dünyada en önemli mortalite ve morbidite sebeplerinden biridir.
CT, MRG ve gibi modern nöroradyolojik görüntüleme teknikleri enfarktüsün ve hemorajinin yerini ve hacmini belirlemede yardımcı olur. Ancak tekrarlanan nöroradyolojik görüntüleme pratik değildir. Beyin hasarlarında S100 protein, NSE, IL-6, myelin bazik protein, glial fibrik asit proteinin kan seviyesini ölçüm tekniği bize daha az riskle daha sık deneme imkanı ve beyin hasarlanmasının ciddiyetini göstermede, hızlı tanı konmasına ve erken tedaviye olanak sağlamaktadır
S-100 asidik bağlayıcı bir proteindir. Protein iki alt birimden oluşmuştur (αveβ). S-100 ββ yüksek konsantrasyonlarda astrosit ve schwan hücrelerinde bulunur. NSE 2- fosfogliseratı fosfoenol pruvata çeviren glikolitik bir enzimdir. Dimerik αα formu glial hücreler için spesifiktir. IL-6 farklı dokuların büyümesi ve farklılaşmasını sağlayan, çok çeşitli fonksiyonları bulunan bir sitokindir. IL-6’nın SSS iskemisinden sonra belirgin olarak nöronal hücre kaybını olduğu bölgelerde arttığı çeşitli çalışmalarda gösterilmektedir.
Son zamanlarda serum S-100 protein, NSE ve IL-6 düzeyi yükselişi ile çeşitli biçimlerdeki akut beyin hasarlanmaları arasındaki ilişki belirlenmiştir.
Serumda NSE ve S100 proteinlerinin ölçümü;Hasara uğrayan dokuların daha çok glial ya da nöronal olduğunun tahmininde, hastalık prognozunun saptanmasında, hasar büyüklüğü ve uygulanacak tedavi stratejisinin belirlenmesinde hastalıkların ayırıcı tanısında tedavi etkinliğinin değerlendirilmesinde önemli bilgiler verir.
Çalışmamızda 50 İskemik ve 25 Hemorajik inme hastası alındı Çalışmaya alınan hastalardan hastaneye yatışlarını takip eden ilk 24 saat içersinde 2.günde,3.günde ve 10.günlerde kontrol grubunda ise bir kez serumdan S100 proteini, NSE ve IL-6 değeri ölçülmüştür.Çalışmaya alınan İskemik inme hastaları Bamford ve arkadaşlarının yaptığı Oxfordshire sınıflandırmasına göre lezyon tipleri belirlenmiştir. Çalışmaya alınan 50 iskemik inme hastası; 14 hasta(%28) LACİ,30 hasta(%60) TACİ,3 hasta(%6) PACİ ve 3 hastada(%6) POCS olarak değerlendirildi. Çalışmaya alınan 25 hemorajik inme hastası ise 17 hasta supratentoryal ve 8 hasta infratentoryal olarak değerlendirildi.
S-100 Proteini ve NSE analizinde İmmunoassay analizör olan modular analytics E170 de ECLİA kulanıldı.
Ölçüm yapılan tüm günlerde NSE, S-100 protein ve IL-6 düzeyleri iskemik ve hemorajik inme hastalarında kontrol gurubuna göre anlamlı düzeyde yüksekti. İskemik inmede en yüksek S100 düzeyi 2. ve 3.günde ölçülmüştür, hemorajik inmeli hastalarda ölçüm yapılan tüm günlerde S100 protein düzeyi yüksek bulunmuş olup, en yüksek düzeyi 3. günde ölçülmüştür. Çalışmamızda TACİ gurubunda en yüksek S100 düzeyleri bulunmuştur. Hemorajik inme geçiren hastalarda ölçüm yapılan tüm günlerde S-100 protein düzeyi yüksek bulunmuştur.En yüksek düzey supratentoryal gurubta tespit edilmiştir. Eks olan iskemik inmeli hastaların taburcu olan iskemik inmeli hastalara göre daha yüksek S-100 protein, NSE ve IL-6 düzeyleri bulunmuştur. Çalışmamızda en yüksek S100 protein düzeyleri NİH skalası 15’den büyük olan hastalarda tespit edilmiştir.En düşük düzey ise NİH skalası 0-1 ile 2-7 arasında olan hastalarda ölçülmüştür. Kötü prognoza sahip hastalarda en yüksek NSE, S100 protein ve IL-6 düzeyleri tespit ettik. S100 protein düzeyi ile enfarktüs boyutu ve uzun dönem nörolojik defisiti belirlemede iyi bir nörobiyokimyasal markır olmakla birlikte enfarkt tanısı için yeterli değildir. S100 protein düzeyindeki zaman içindeki değişimler klinik sonuçlarla iyi bir korelasyon gösterir. Özelikle nörolojik defisit ve serebral hasar artıkça S100 ve NSE düzeyinin belirgin bir biçimde artığını,nörolojik defisiti kötü ve eks olan hastalarda S100 protein, NSE ve IL-6 düzeylerini daha yüksek bulduk. Ayrıca iskemik lezyon ve hemorajilede S100 düzeyinde artış NSE göre daha belirgin olmaktadır.Böylece çalışmamızın sonucunda iskemik ve hemorajik inmelerde nörolojik defisiti tahmin etmede, tedavide ,takip ve prognozda önemli markırlar olduğu, S100 proteinin NSE’ye göre SSS hastalıklarına daha özgül olduğu görülmektedir. Yüksek S100 proteini tespit edilen inmeli hastalarda artmış IL- 6 ile anlamlı bir korelasyon göstermiştir.
7- SUMMARY
Stroke (Ictus) is defined being influenced of a part of brain result of ischemia or hemorrhage temporarly or permanently. And one or more blood vessels which connect with brain are defined as primer patology. Among the all ictuses (stroke) the brain infarct is %70-80 , intra – cerebral Hemorrhage is % 7-15 and subarachnoin hemorrhage is 2-8 stroke is not only seen in developed countries but alsa it is the most important reason of mortality or morbidinty. The modern menitorins techniques (like CT,MRG) help clinicians to identify the location and the volume of infarct and hemorrhage however repeating them for monitoring is impractical ln brain damages, S100 is protein, NSE , İL-6 , myelin basic protein and the measure
technique of blood level help us/show us opportunity the more testing with the less risk and brain damages and to diagnose and early therapy.
S100 is a connective acidity protein. Protein consists of two units S100 ββ ewists in astrocyte and shwann cells while high concentrations. NSE 2 is an enzyme which translates the phosphoglycerat to phosphoenol pyruvate. Dimeric αα form is specific for gliyal cells. IL-6 is a cytokine has many different functions enable to growth and differentations of different tissues. ln many studies shown that İL-6 is increasing in the location of loss cel. Recently the relations between increasing inleve serum s100 protein, NSE an IL-6 and different acute brain damages have been revealed. The testing of NSE and S100 proteins give important knowledges in the estimate of establish the illness oragnosis, the statement of damage , the dete minate of therapy,toevalvate the therapy. ln our study,we have taken 50 patients with ischemic and 25 patients with hemarogic. The patients participating in the study were measured serum S100 protein, NSE and İL-6 on admission (within 24 hours) on second and third and tenth days. But the control group was measured only one time. Patients with ischemic were grouped according to lesion types categorizated by bamford and his friends . patients with ischemic were evaluated LAC1 n=14 (%28),TACI n=3(%6) and POCS n=3(%6) Patients with hemarogic were evaluated supratentorial n:17, and in fratentorial n=8
The Immunoasay analysis was used for S100 Protein and NSE .The ECLIA analysis was used form odular analytics E170.
In all measured days NSE ,S100 protein and IL-6 have maunhy increaced in patients with ischemic and hemorogic to control group. On the patients with ischemic, the highest S100 level was measured on secand and third days. Although (the patients with hemorogic) S100 protein level was measured in all days and found the protein level high, the highest level was measured on third day.In our study the highest S100 level was found in TACI group In the
patients with hemorogic stroke were found high S100 level on the measuremeıt days, the highest level was revealed in supramentorial grouphad It was found that the patients with ischemic (ex) had much more S100 protein NSE and IL-6 than discharged patients with ischemic. In our study the highest S100 protein and levels were seen over is years.The
minimum level is measured between 0-1 and 2-7 with NIH scala. We found the highest NSE, S100 protein and IL-6 levels among the bad prognosis patients. The frequency variations of S100 protein level show a good correlation with clinical results.
Especially,when neurologic deficit and cerebral damage are increasing S100 and NSE levels are dearly inreasing too. We found also hing S100 protein, NSE and İL-6 level with bad neurologic deficit and eks besides, the increation in S100 on the patients with ischemic lesion and hemorrhage is more clear than. NSE.
Consequentlu there are important markers to estimate neurogic deficit, to therapy, to follow the course of disease and to prognose when the patients ischemic and hemorogic. Besides S100 protein is more specific to SSS than NSE.
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