A method for predicting the course of ischemic stroke

 

(57) Abstract:

The invention relates to medicine, namely neurology, and for predicting the course of ischemic stroke by holding immunophenotyping of lymphocytes. The essence of the method is that at 1, 10, 21 days from the date of development of ischemic stroke determine the average level of CD95-lymphocytes, %, when the value of the level of CD95-lymphocytes on day 1 over 7.2±2.8% and the return to normal on day 21 predict a favorable outcome at the level of CD95-lymphocytes above to 7.2±2.8% and the average index level on day 21 - predicts favorable prognosis for life and not conducive to the recovery of neurological deficit, and when the value of the average CD95-cells above 29,12±3,1% - predict poor prognosis for life. The technical result is to develop a method that ensures a high accuracy of prediction, allowing for adequate therapy. table 1.

The invention relates to medicine, namely to neurology. Acute disorders of cerebral circulation (of stroke) are the most important medico-social problem due to their high share in the structure of morbidity and mortality neselesoobraznosti disease is about 400 persons per 100 thousand population. The mortality rate over the last 15 years has increased by 18% and reached 280 persons per 100 thousand population. Mortality from vascular diseases of the brain in our country occupies the 2nd place, which is not much inferior to mortality from cardiovascular diseases. Therefore, the prognosis of stroke is of great importance in practical neurology.

As a prototype, the authors propose “a Method of predicting the course of ischemic stroke” (patent No. 2195672 from 30.03. 2001, Bulletin No. 36 dated 27.12.2002, M. M. Gerasimova, G. N. Zhdanov and Y. the Century Already), consisting in the determination in the serum of patients with ischemic stroke level of anti-DNA method enzyme immunoassay. To this end, the authors investigated the serum of patients to 1.10 and 21st day of the disease with subsequent conduct clinical and immunological analysis. Was significantly (P0,05) revealed that increasing the level of anti-DNA on day 1 within 0,196±0,01% OP and reduced almost to normal 21-day - forecast favorable, if at the 21st day, the level of anti-DNA higher than in the control group and by 21-th day the level of anti-DNA remained approximately at the same level, the prognosis is relatively favorable for life, but unfavorable sopretty for life.

Some disadvantage of this method is the low availability and high cost of instrumentation and test systems.

The authors propose a way of predicting the course of ischemic stroke by way of immunophenotyping of lymphocytes. Lymphocytes isolated from heparinized blood by centrifugation on a gradient ficoll-orografii (density of 1.077 g/ml). 1 ml of cells in a volume of 50 μl contribute to the centrifuge tube and add 5 ál of the test CD95 monoclonal antibodies, followed by incubation for 30 minutes Then add 150 μl of Hanks solution and centrifuged 5 min at 200 g, remove the supernatant, then again make 150 μl of Hanks solution, suspended and centrifuged again. To the precipitate add 50 ál of fragments of sheep antibodies labeled with fitzum with subsequent suspendirovanie and incubation. Double-washed cells are ready for viewing in a fluorescent microscope. The number of antigen positive cells is defined as the percentage fluorochrome cells while browsing 200 lymphocytes minus percent fluorochrome cells observed in the preparation of the negative control (Annex to licence No. 42/98-065-0509 from 06.05.1998, “the List of medical products, authorized for ispolzovaniem compared with the control group, which amounted to 7.2+2.8 per cent (n=30).

All patients were sampling venous blood to determine the average level of CD95 - cells at 1, 10 and 21 days from the date of development of ischemic stroke. The applicants propose to produce blood from the cubital vein on day 1 after onset of the disease (because it is the acute period, in order to confirm the presence or absence of increasing the level of CD95-lymphocytes), on the 10th day (because by this time should be the maximum response of the immune system on the action of damaging factors of acute ischemia), on the 21st day (with the aim of examining the consequences of the immune process).

In the clinic examined 47 patients. Of them selected 3 groups depending on the outcome of the disease. 1st group (12 patients) - patients with almost complete recovery of neurological deficits. This group of patients the level of CD95-lymphocytes on day 1 was 11,16±1,79%, 10-day - 7,5±2,05%, on the 21st day of 5.3±1.13 per cent. 2nd group (23 persons) - patients who have remained persistent neurological deficit to the 21st day. In this group the level of CD95 in 1 day -18,52±3,68%, 10-day - 17,88±1,11%, and 21-day - 17.11 per bbl±0,89%. 3 group (13 persons) - patients with a poor prognosis for life (fatal). In the 3rd group in 1-day - 29,12 ne) was practically healthy people, have CD95 amounted to 7.2±2.8 per cent. Clearly clinical and immunologic data are grouped in the table.

Reliability P0,05

Thus, it was reliably established that with increasing level of CD95 in 1 day over 7.2±2.8% and return almost to normal on day 21 shows a favorable outcome of stroke. If on day 1, the level of CD95 above 14.8%, while the 21-th day this rate is kept at the same level, the prognosis is relatively favorable for life, but not favorable for the recovery of neurological deficits. If the level of CD95 above 29,12±3,01% - the prognosis is poor for life.

The method does not require expensive equipment, simple in execution, reliably predict the course of ischemic stroke, which helps to make timely adjustments in therapy, and thus, to influence the level of mortality and disability.

Clinical example:

1. Grigoriev C. I., 62, and/b No. 9134

s: ischemic stroke in the basin of the right middle cerebral artery with atherosclerosis of cerebral vessels and hypertension with mild left-sided hemiparesis.

The level of CD95 blood:

1st day - 15%

day 10 - 29%

21-the m deepening focal neurological symptoms with a change of consciousness, however, the negative dynamics quickly cropped conduct of optimal therapy, which led to a significant improvement of the patient and to significantly less neurological deficit on day 21 (continued light, more a reflex left Gameport) that corresponds to the level of CD95-lymphocytes (7%) on 21-th day of the disease.

2. Reshetov Y. C., 65 years old, and a/b No. 5195

s: main: ischemic stroke in the right middle cerebral artery in hypertension.

Complications: swelling and dislocation brain

The SOP.s: consequences of ischemic stroke in the right MCA.

day 1 - the level of CD95-lymphocytes 25%.

The patient had high numbers D95-lymphocytes, which corresponds to the unfavorable course of the stroke. Fatal outcome in a patient came in 3 days from the beginning of ischemic stroke.

A method for predicting the course of ischemic stroke, including the study of blood, characterized in that in the venous blood by way of immunophenotyping of lymphocytes at 1, 10, 21 days from the date of development of ischemic stroke, determine the average level of CD95-lymphocyte percentage at level T-lymphocytes on day 1 more (7,2±2,8)% and return to the level of the index on the 21st day predicts favorable prognosis for life and not conducive to the recovery of neurological deficit, and a value of the average CD95-cells above (29,12±3,1)% - predict poor prognosis for life.

 

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