Study of some immunological markers in acute cerebrovascular ischemic stroke

ABSTRACT

Ischemic stroke is associated with a high rate of mortality and morbidity in the world. Several mechanisms for neuroprotection against ischemia have been studied and included inflammatory mediators and apoptotic inducers and suppressors. The aim of this study was to clarify the role of some immunological markers [TNF-alpha, sFas and BCL-2] in the pathogenesis of cerebral ischemia and to relate their levels to the size of brain infarction and prognostic outcome of ischemic stroke. This study was done on 60 patients suffering from acute cerebrovascular ischemic stroke [40 males and 20 females] with age ranged from 45-70 years and 15 healthy subjects as a control group. History taking, clinical examination, laboratory investigations were performed to all subjects and CT scan brain was done for patients. There was a highly significant statistical difference between the patients and control group as regard the level of the immunological markers and there was a direct relationship between risk factors as TIAs and TNF-alpha level and sFas level among the patients with increased level of these 2 markers in comparison to those with normal level. On the other hand, there was an inverse positive relationship between presence of hypertension, diabetes and TIAs and BCL-2 level among the patients with decreased level of BCL-2 in comparison with those with normal level. Also, there was a highly significant positive correlation between both of TNF-alpha level and sFas level and signs of inflammation as fever, elevated ESR and leukocytosis in the patients and a significant positive correlation with the NIH-NINDS score of stroke. While there was a highly significant negative correlation between BCL-2 level and WBCs, ESR and NIH-NINDS score. There was a direct positive relationship between both of TNF-alpha level and sFas level and size of brain infarction and presence and degree of brain oedema among the patients while an inverse positive relationship was found between these CT parameters and BCL-2 level. There was a significant statistical difference between survived and died groups of patients as regard BCL-2 level and qualitative presence of CRP+. Neuronal death in acute ischemic stroke is attributed in part to inflammation and apoptosis