مرکز منطقه ای اطلاع رساني علوم و فناوري - The relationship of intrathecal immunoglobulin levels with clinic symptoms and prognosis for acute phase ischemic stroke patients

Abstract :

Aim. Ischemic strokes are about 80-85% of the strokes, third common cause of mortality in the world. Due to ischemia, neurons are damaged, blood brain barrier (BBB) is disrupted and inflammation is triggered. Although the cell mediated immun response in ischemic stroke has been showed by previous studies,there is no excessive database is available for humoral immun response. In this study, we aim to determine presence and amount of intrathecal immunglobulins after ischemic strokes as a result of humoral immun response in patients with the first and recurrent ischemic stroke. Thus,we could elucidate the presence of humoral immune response effect 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, A and albumin levels were measured simultaneously. Albumin and Ig G index and CSF Ig G/CSF albumin ratios were calculated. Infarct volumes of the patients were calculated from computed cranial 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 at the admission, modified Rankin Scale (MRS),Barthel index (BI) and NIHSS were used at the time of discharge from the hospital. Results. Albumin index was normal in the patients with their first ischemic stroke but slightly elevated in the recurrent ischemic stroke group. The CSF Ig G levels (p 0.001), CSF Ig G/CSF albumin ratio (0.32 ± 0.04) and CSF Ig G index, (1.13 ± 0.16) were higher in the recurrent ischemic stroke group. Also unlike the first group, in the recurrent ischemic stroke, there was a a significant positive correlation between the infarct volumes and levels of IgG (p 0.001). Considering to MRS and BI, MRS was higher in recurrent ischemic stroke group (p=0.001) and Barthel index was lower (p=0.009). Conclusion. Our results showed the intrathecal synthesis of IgG in recurrent ischemic stroke and the role of humoral immune system in the pathophysiology of recurrent ischemic stroke. However the effect of humoral immune system on the patients’clinic, the prognosis of stroke and disability due to stroke is contraversial.