Türk Beyin Damar Hast Derg. 2002; 8(1): 1-7

Complement system in acute hemorrhagic stroke

Gürdal Orhan, Þerefnur Öztürk, Þenay Özbakýr
Ankara Numune Research And Training Hospital, Neurology Clinic, Ankara

INTRODUCTION: The role of the complement system in cerebrovascular events has recently been discussed with ever-increasing demand. In hemorhagic stroke, the complement system interacts with the coagulation system and inflammation and it shows changes. In this study we studied whether the complements components, namely C3,C4 serum levels, serum Ig levels (A,G,M), number of leukocytes, and fibrinogen levels showed any differences from the control group and studied the time based progress of these parameters and their relations with the clinical and CT parameters.
METHODS: In the study we covered 87 acute hemorrhagic stroke patients and 46 controls who were admitted in our clinic between April and November 1999. Patients were selected into the study with the conditions of being in the initial three days of acute hemorrhagic stroke, not having any collagen tissue diseases, any previous surgical operations, angiography, myocardial infarction, angina pectoris and history of trauma in the last three months and not having any infectious findings and any known malignity. Similar conditions apart from the stroke were applied to the controls as well. In the first 5th and 10th days serum C3, C4, IgA, IgG, IgM and fibrinogen levels of the patients were measured, which were later evaluated in terms of their relations with clinical and CT findings.
RESULTS: With regard to the average age, no difference was found between 87 acute hemorrhagic stroke patients and 46 controls (p= 0.165). Serum C3 levels of the patients measured in the first 5th day of the stroke were found significantly higher than the control group (1.341± 0.544 and 1.169± 0.171 respectively) (p=0.043). C4 levels were found higher than the control group (0.387±0.223, 0.223±0.118 respectively) (p=0.000). Serum IgA and M levels and number of leukocytes were higher in the stroke group for the initial 5 days (p= 0.016, 0.034, 0.000, respectively). However, we found out that fibrinogen levels raised distinctively in the 10th day (p= 0.000). In those with lesion volumes > 30 cm3 on the CT, C3 levels have no statistical importance but they were found high (p= 0.073). A positive correlation was established between C3 levels and the lesion volume (p=0.041). C3 levels measured on the 10th day in the patients who died, were found higher than those of alive (p= 0.045).
DISCUSSION AND CONCLUSION: As a result, we think that the complement system is affected in hemorrhagic stroke and this is particularly in hyperacute period and that complement components have relations with the immunologic and clinical parameters.

Keywords: Hemorrhagic stroke, complement, C3, C4.

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Akut hemorajik strokta kompleman sistem

Gürdal Orhan, Þerefnur Öztürk, Þenay Özbakýr
Ankara Numune Eðitim Ve Araþtýrma Hastanesi, Nöroloji Kliniði, Ankara

GÝRÝÞ ve AMAÇ: Serebrovasküler olaylarda kompleman sistemin rolü son yýllarda artan ilgiyle tartýþýlmaya baþlanmýþtýr. Hemorajik strokta kompleman sistem, koagülasyon sistemi ve enflamasyonla etkileþmekte ve deðiþim göstermektedir. Bu çalýþmada hemorajik strokta kompleman komponentlerinden C3 ve C4 serum düzeylerinin, serum Ig düzeylerinin (IgA, G, M), lökosit sayýsý ve fibrinojen düzeylerinin kontrol grubundan farklýlýk gösterip göstermediðini ve bu parametrelerin zamana baðlý deðiþimini, klinik ve CT parametreleri ile iliþkisini araþtýrdýk.
YÖNTEM ve GEREÇLER: Ankara Numune Eðitim ve Araþtýrma Hastanesi Nöroloji Kliniðine 4.1999 – 11.1999 tarihleri arasýnda kabul edilen 87 akut hemorajik strok hastasý ve 46 kontrol çalýþýldý. Hastalarýn çalýþmaya alýnma kriterleri olarak akut hemorajik strokun ilk 3 gününde olmalarý, kollajen doku hastalýðýnýn olmamasý, son 3 ayda geçirilmiþ cerrahi giriþim, anjiyografi, MI, angina pektoris, travma öyküsünün olmamasý, enfeksiyon bulgularýnýn olmamasý, bilinen bir malignitesinin olmamasý olarak belirlendi. Kontrol grubu için de strok dýþýnda benzer kriterler arandý. Hastalarýn ilk 5 ve 10. günlerinde serum C3,C4, IgA, G, M ve fibrinojen deðerleri ölçüldü. Ölçülen parametrelerin klinik ve CT bulgularý ile iliþkisi deðerlendirildi.
BULGULAR: Çalýþmaya alýnan 87 akut strok hastasý (yaþ ort.: 59.643±10.611) ile 46 kontrol (yaþ ort.: 62.043±6.596) arasýnda yaþ ortalamalarý için farklýlýk bulunmadý (p=0.165).
Strokun ilk 5 gününde ölçülen serum C3 düzeyleri hasta grubunda (1.341±0.544) kontrol grubundan (1.169±0.171) belirgin olarak yüksek bulundu (p=0.043). C4 düzeyleri hasta grubunda (0.387±0.223) kontrol grubundan yüksek bulundu (p=0.000). Serum IgA ve M düzeyleri ve lökosit sayýsý ilk 5 günde strok grubunda yüksekti (sýrasýyla p=0.016; 0.034; 0.000). Strokun 10. gününde serum C3 ve C4 düzeylerinin belirgin þekilde azaldýðý izlendi (sýrasýyla p=0.000; p=0.031). Buna karþýlýk fibrinojen düzeyinin 10. günde belirgin yükselme gösterdiðini bulduk (p=0.000). CT´de lezyon boyutu ≥ 30 cm3 olanlarda C3 düzeyi ile lezyon boyutu arasýnda pozitif korelasyon saptandý (p=0.041). Ex olan hastalarda 10. günde ölçülen C3 düzeyi eksitus olmayanlardan istatistiksel olarak yüksek bulundu (p=0.045).
TARTIÞMA ve SONUÇ: Sonuç olarak; hemorajik strokta kompleman sistemin etkilendiði, bu etkileþmenin özellikle hiperakut dönemde belirgin olduðu ve kompleman komponentlerinin diðer immünolojik parametreler ve klinik parametrelerle iliþkisi olduðu düþünüldü.

Anahtar Kelimeler: Hemorajik strok, kompleman, C3, C4.

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