Changes in Markers of Neuro-Immune Disintegration in the Sub-Acute Phase of Ischemic Stroke

Abstract

Background. The increase in the prevalence of CVZ gives reasons to consider the problem of combating stroke as a priority area of treatment and prevention work of medical workers all over the world.
 Aim: assessment of the role of changes in markers of neuroimmune disintegration in the acute phase of ischemic stroke.
 Material and methods. The study was conducted on the basis of the clinical units of the Medical Institute of the Black Sea National University named after Peter Mohyla (Mykolaiv, Odesa) in 2020-2022. At the first stage, a retrospective analysis of 150 disease histories of patients who underwent II and were undergoing rehabilitation at the "Expert Health" medical center was carried out. At the second, prospective stage, 28 patients who had II in the subacute period were examined with an in-depth immunological examination. An analysis of the dynamics of leukogram indicators, CRP, procalcitonin and other markers of inflammation was carried out. At the prospective stage, the blood content of pro-inflammatory cytokines (TNF, IL1, IL2, Il6) and anti-inflammatory cytokines (IL4, IL10) was additionally determined. Statistical processing was carried out by methods of dispersion and correlation analysis using Statistica 14.0 software (TIBCO, USA).
 Results. According to the retrospective analysis, the severity of changes in leukogram and CRP content correlated with the severity of II (r=0.11-0.29). With an average NIHSS score of 10.8±0.9, the content of lymphocytes in the peripheral pool averaged 17.3±0.4%, while the total content of leukocytes was 9.4±0.2 G/l. 76 (50.7%) patients had records in their medical records regarding the assessment of the CRP level, which averaged 7.7±0.9 mg/l. In 72.7% of patients, manifestations of atherosclerosis of brachiocephalic vessels were determined, including in 31.3% - signs of critical stenosis of the carotid arteries. When comparing the levels of CRP and the severity of the atherosclerotic process, a positive correlation of average strength was found (r=0.31).
 It is shown that in the subacute period at the stage of rehabilitation, the leukogram normalizes, the manifestations of the systemic inflammatory response decrease. At the same time, there are signs of stress on neuroimmune regulatory mechanisms and the need to monitor inflammatory biomarkers both in the acute and subacute stages of stroke.
 Conclusions. The expressiveness of changes in leukogram and CRP content correlates with the severity of II, and high levels of CRP are a predictor of an adverse clinical outcome. When comparing the levels of CRP and the severity of the atherosclerotic process, a positive correlation of average strength was found (r=0.31). With an ischemic stroke, neuroimmune regulatory mechanisms are stressed in the subacute stage of the disease. It is advisable to monitor inflammatory biomarkers both in the acute and subacute stages of stroke.

Cerebrocardial Continuum in Patients After a Stroke

“…Поточні дані переконливо підтверджують, що стрес, спричинений інсультом призводить до гіперактивації структур центральної вегетативної мережі із залученням гіпоталамо-гіпофізарно-наднирникової осі [43][44][45]. В наслідок цього виникають зміни у вегетативній регуляції скорочувальної функції міокарда за типом гіперсимпатикотонії.…”