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Akut İskemik İnmede Yeni Bir Biyobelirteç Olan Serum NR2 Düzeyinin İnmenin Şiddeti ve Prognozu ile İlişkisi

Year 2013, Volume: 23 Issue: 4, 114 - 119, 01.01.2013

Abstract

Giriş: Akut iskemik inme tanısı için klinik deneyim ve görüntüleme bulgularını destekleyecek kan testine ihtiyaç vardır. Bu çalışma- da serum NR2 antikor düzeyinin akut iskemik inme tanısındaki değerinin ortaya konması amaçlandı. Gereç ve yöntem: Çalışmaya prosfektif olarak, çalışmaya alınma kriterlerini dolduran 64 iskemik inmeli hasta ile 68 sağlıklı gönüllü dahil edildi. İskemik inmenin akut döneminde serum NR2 anikor düzeyi ELİSA yöntemi ile ölçüldü. İnmenin şiddeti ve prognozu, giriş NIH İnme Skalası, 3. Ay modifiye Rankin Skalası ve Barthel indexi skorları ile, enfarkt hacmi AXBXC/2 hesaplamasıyla belirlendi. Sonuçlar Kolmogorov Smirnov, Tukey HSD, Wilcoxon ve Mann-Whitney U Testi kullanılarak NR2 düzeyi ile kıyaslandı. Bulgular: Ortalama serum NR2 antikor düzeyi iskemik inme grubunda 2.64±1.43 iken, kontrol grubunda 2.28±1.13 idi. Gruplar arasındaki fark istatistiksel olarak anlamlı değildi. S100B değerlerinin yaş, cinsiyet, koroner arter hastalığı, diyabetes mellitus, hiperlipidemi, hipertansiyon, periferik damar hastalığı, sigara içiminden etkilenmediği görülmüştür. Sonuç: Bu çalışma sonuçları NR2 antikor düzeyinin akut iskemik inmeli hastalardaki serum düzeylerinin normal kontrollere göre farklı olmadığını gösterdi. Bu verilere göre iskemik inmede NR2 antikor düzeyinin etkili bir rol almadığını düşünüyoruz

References

  • Hankey GJ, Stroke. How large a public health problem and how can the neurologist help? Arch Neurol 1999;56:748-54.
  • Herman B, Leyten AC, van Luijk JH, et al. Epidemiology of stroke in Tilburg, the Netherlands. The population-based stroke inciden- ce register: 2. Incidence, initial clinical picture and medical care, and three-week case fatality. Stroke 1982;13:629-34.
  • Roger VL, Go AS, Lloyd-Jones DM, et al. Executive summary: he- art disease and stroke statistics--2012 update: a report from the American Heart Association. Circulation 2012;125:188-97.
  • Jensen MB, Chacon MR, Sattin JA, et al. Potential biomarkers for the diagnosis of stroke. Expert Rev Cardiovasc Ther 2009;7:389- 93.
  • Yip TR, Demaerschalk BM. Estimated cost savings of increased use of intravenous tissue plasminogen activator for acute ischemic stroke in Canada. Stroke 2007;38:1952-5.
  • Lynch JR, Blessing R, White WD, et al. Novel diagnostic test for acute stroke. Stroke 2004;35:57-63.
  • Tonarelli SB, Hart RG. What’s new in stroke? The top 10 for 2004/05. J Am Geriatr Soc 2006;54:674-9.
  • Saenger AK, Christenson RH. Stroke biomarkers: progress and challenges for diagnosis, prognosis, differentiation, and treatment. Clin Chem 2010;56:21-33.
  • Petrie RX, Reid IC, Stewart CA. The N-methyl-D-aspartate recep- tor, synaptic plasticity, and depressive disorder. A critical review. Pharmacol Ther 2000;87:11-25.
  • Guard DB, Swartz TD, Ritter RC, et al. Blockade of hindbrain NMDA receptors containing NR2 subunits increases sucrose in- take. Am J Physiol Regul Integr Comp Physiol 2009;296:R921-8.
  • Gascon S, Sobrado M, Roda JM, et al. Excitotoxicity and focal ce- rebral ischemia induce truncation of the NR2A and NR2B subu- nits of the NMDA receptor and cleavage of the scaffolding protein PSD-95. Mol Psychiatry 2008;13:99-114.
  • Macrez R, Bezin L, Le Mauff B, et al. Functional occurrence of the interaction of tissue plasminogen activator with the NR1 Su- bunit of N-methyl-D-aspartate receptors during stroke. Stroke 2010;41:2950-5.
  • Donnan GA, Baron JC, Ma H, et al. Penumbral selection of pa- tients for trials of acute stroke therapy. Lancet Neurol 2009;8:261- 9.
  • Laskowitz DT, Kasner SE, Saver J, et al. Clinical usefulness of a biomarker-based diagnostic test for acute stroke: the Biomar- ker Rapid Assessment in Ischemic Injury (BRAIN) study. Stroke 2009;40:77-85.
  • Gappoeva MU, Izykenova GA, Granstrem OK, et al. Expression of NMDA neuroreceptors in experimental ischemia. Biochemistry (Mosc) 2003;68:696-702.
  • Brouns R, De Deyn PP. The complexity of neurobiological proces- ses in acute ischemic stroke. Clin Neurol Neurosurg 2009;111:483- 95.
  • Görgülü A, Kırış T. Eksitator aminoasidler ve eksitotoksisite. Türk Nöroşirürji Derg 2005;15:33–8.
  • Bhatia RS, Garg RK, Gaur SP, et al. Predictive value of routine hematological and biochemical parameters on 30-day fatality in acute stroke. Neurol India 2004;52:220-3.
  • Betzen C, White R, Zehendner CM, et al. Oxidative stress upregu- lates the NMDA receptor on cerebrovascular endothelium. Free Radic Biol Med 2009;47:1212-20.
  • Goebel DJ, Poosch MS. NMDA receptor subunit gene expression in the rat brain: a quantitative analysis of endogenous mRNA le- vels of NR1Com, NR2A, NR2B, NR2C, NR2D and NR3A. Brain Res Mol Brain Res 1999;69:164-70.
  • Dambinova SA, Bettermann K, Glynn T, et al. Diagnostic potenti- al of the NMDA receptor peptide assay for acute ischemic stroke. PLoS One 2012;7:e42362.
  • Weissman JD, Khunteev GA, Heath R, et al. NR2 antibodies: risk assessment of transient ischemic attack (TIA)/stroke in patients with history of isolated and multiple cerebrovascular events. J Neurol Sci 2011;300:97-102.
  • Bokesch PM, Izykenova GA, Justice JB, et al. NMDA receptor anti- bodies predict adverse neurological outcome after cardiac surgery in high-risk patients. Stroke 2006;37:1432-6.
  • Glynn T, Tews M, Izykenova G, et al. The clinical utilty of se- rum NR2 peptid assay in the diagnosis of patient presenting to the emergyncy depertmant with acute cerebrovasculer ischemic events. Ann Emerg Med 2007; 50: S35.
  • Brightwell RE, Sherwood RA, Athanasiou T, et al. The neurologi- cal morbidity of carotid revascularisation: using markers of cellu- lar brain injury to compare CEA and CAS. Eur J Vasc Endovasc Surg 2007;34:552-60.

The relationship between serum levels of a novel biomarker NR2 antibody and acute ıschemic stroke prognosis and severity

Year 2013, Volume: 23 Issue: 4, 114 - 119, 01.01.2013

Abstract

Objectives: A blood test supporting the clinical and radiological findings used for the diagnosis of acute ischemic stroke AIS is nee- ded. The aim was to demonstrate the value of serum NR2 antibody levels for the differential diagnosis of AIS. Material and method: Sixtyfour ischemic stroke patients and 68 healthy volunteers who fulfilled the study criteria are included to our study prospectively. Serum NR2 antibody levels calculated by ELISA method at period of the acute ischemic stroke. Severity and prognosis of stroke are determined by on admission NIHSS score, third month MRS and Barthel index scores, infarction volume with AXBXC/2 calculation. Results are compared with NR2 antibody levels by using Kolmogorov Smirnov, Tukey HSD, Wilcoxon and Mann-Whitney U tests. Results: Average serum NR2 antibody levels are 2.64±1.43 and 2.28±1.13 in ischemic stroke and control groups respectively. The dif- ference between two groups is found statistically insignificant. It is understood that S100B levels are not affected by age, gender, coro- nary artery diseases, diabetes mellitus, hyperlipidemia, hypertension, peripheral artery disease or smoking. Conclusion: These results suggest that serum NR2 antibody levels in the patients with acute ischemic stroke do not show a statistically significant difference when compared to healthy controls. We conclude that serum NR2 antibody levels have no important effect on the ischemic stroke

References

  • Hankey GJ, Stroke. How large a public health problem and how can the neurologist help? Arch Neurol 1999;56:748-54.
  • Herman B, Leyten AC, van Luijk JH, et al. Epidemiology of stroke in Tilburg, the Netherlands. The population-based stroke inciden- ce register: 2. Incidence, initial clinical picture and medical care, and three-week case fatality. Stroke 1982;13:629-34.
  • Roger VL, Go AS, Lloyd-Jones DM, et al. Executive summary: he- art disease and stroke statistics--2012 update: a report from the American Heart Association. Circulation 2012;125:188-97.
  • Jensen MB, Chacon MR, Sattin JA, et al. Potential biomarkers for the diagnosis of stroke. Expert Rev Cardiovasc Ther 2009;7:389- 93.
  • Yip TR, Demaerschalk BM. Estimated cost savings of increased use of intravenous tissue plasminogen activator for acute ischemic stroke in Canada. Stroke 2007;38:1952-5.
  • Lynch JR, Blessing R, White WD, et al. Novel diagnostic test for acute stroke. Stroke 2004;35:57-63.
  • Tonarelli SB, Hart RG. What’s new in stroke? The top 10 for 2004/05. J Am Geriatr Soc 2006;54:674-9.
  • Saenger AK, Christenson RH. Stroke biomarkers: progress and challenges for diagnosis, prognosis, differentiation, and treatment. Clin Chem 2010;56:21-33.
  • Petrie RX, Reid IC, Stewart CA. The N-methyl-D-aspartate recep- tor, synaptic plasticity, and depressive disorder. A critical review. Pharmacol Ther 2000;87:11-25.
  • Guard DB, Swartz TD, Ritter RC, et al. Blockade of hindbrain NMDA receptors containing NR2 subunits increases sucrose in- take. Am J Physiol Regul Integr Comp Physiol 2009;296:R921-8.
  • Gascon S, Sobrado M, Roda JM, et al. Excitotoxicity and focal ce- rebral ischemia induce truncation of the NR2A and NR2B subu- nits of the NMDA receptor and cleavage of the scaffolding protein PSD-95. Mol Psychiatry 2008;13:99-114.
  • Macrez R, Bezin L, Le Mauff B, et al. Functional occurrence of the interaction of tissue plasminogen activator with the NR1 Su- bunit of N-methyl-D-aspartate receptors during stroke. Stroke 2010;41:2950-5.
  • Donnan GA, Baron JC, Ma H, et al. Penumbral selection of pa- tients for trials of acute stroke therapy. Lancet Neurol 2009;8:261- 9.
  • Laskowitz DT, Kasner SE, Saver J, et al. Clinical usefulness of a biomarker-based diagnostic test for acute stroke: the Biomar- ker Rapid Assessment in Ischemic Injury (BRAIN) study. Stroke 2009;40:77-85.
  • Gappoeva MU, Izykenova GA, Granstrem OK, et al. Expression of NMDA neuroreceptors in experimental ischemia. Biochemistry (Mosc) 2003;68:696-702.
  • Brouns R, De Deyn PP. The complexity of neurobiological proces- ses in acute ischemic stroke. Clin Neurol Neurosurg 2009;111:483- 95.
  • Görgülü A, Kırış T. Eksitator aminoasidler ve eksitotoksisite. Türk Nöroşirürji Derg 2005;15:33–8.
  • Bhatia RS, Garg RK, Gaur SP, et al. Predictive value of routine hematological and biochemical parameters on 30-day fatality in acute stroke. Neurol India 2004;52:220-3.
  • Betzen C, White R, Zehendner CM, et al. Oxidative stress upregu- lates the NMDA receptor on cerebrovascular endothelium. Free Radic Biol Med 2009;47:1212-20.
  • Goebel DJ, Poosch MS. NMDA receptor subunit gene expression in the rat brain: a quantitative analysis of endogenous mRNA le- vels of NR1Com, NR2A, NR2B, NR2C, NR2D and NR3A. Brain Res Mol Brain Res 1999;69:164-70.
  • Dambinova SA, Bettermann K, Glynn T, et al. Diagnostic potenti- al of the NMDA receptor peptide assay for acute ischemic stroke. PLoS One 2012;7:e42362.
  • Weissman JD, Khunteev GA, Heath R, et al. NR2 antibodies: risk assessment of transient ischemic attack (TIA)/stroke in patients with history of isolated and multiple cerebrovascular events. J Neurol Sci 2011;300:97-102.
  • Bokesch PM, Izykenova GA, Justice JB, et al. NMDA receptor anti- bodies predict adverse neurological outcome after cardiac surgery in high-risk patients. Stroke 2006;37:1432-6.
  • Glynn T, Tews M, Izykenova G, et al. The clinical utilty of se- rum NR2 peptid assay in the diagnosis of patient presenting to the emergyncy depertmant with acute cerebrovasculer ischemic events. Ann Emerg Med 2007; 50: S35.
  • Brightwell RE, Sherwood RA, Athanasiou T, et al. The neurologi- cal morbidity of carotid revascularisation: using markers of cellu- lar brain injury to compare CEA and CAS. Eur J Vasc Endovasc Surg 2007;34:552-60.
There are 25 citations in total.

Details

Primary Language Turkish
Journal Section Original Article
Authors

Ersin Kasım Ulusoy This is me

Erdem Gürkaş This is me

Cevdet Zungun This is me

Mehmet İlker Yön This is me

Sevilay Sezer This is me

Fikri Ak This is me

Publication Date January 1, 2013
Published in Issue Year 2013 Volume: 23 Issue: 4

Cite

Vancouver Ulusoy EK, Gürkaş E, Zungun C, Yön Mİ, Sezer S, Ak F. Akut İskemik İnmede Yeni Bir Biyobelirteç Olan Serum NR2 Düzeyinin İnmenin Şiddeti ve Prognozu ile İlişkisi. Genel Tıp Derg. 2013;23(4):114-9.

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