الفهرس 
ACUTE ISCHEMIC STROKEOnly 14 pages are availabe for public view
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Abstract
S
troke remains the third leading cause of death in the world and the major cause of adult disability. At many community hospitals, a formal stroke team or neurologist may not be available. MR-based technology is unlikely to become widely available for most patients presenting to nonacademic facilities with acute stroke syndromes. Thus, an additional benefit of obtaining a panel of markers might be useful to help stroke patients.
S100B protein belongs to large multigenic family of calcium-modulated proteins. It is found in abundance in astroglial compartment of the brain, in Schwann cells of the peripheral nervous system and extraneuronally in melanocytes, adipocytes and chondrocytes. Traditionally, S100B has been considered a reliable marker of astrocytic brain damage. However, recent study has shown that S100B is localized in many cell types in human brain including astrocytes, oligodendrocytes and neurons. It has also been suggested that S100B may be a marker of blood-brain barrier dysfunction rather than specifically astrocytic damage.
This study aimed to investigate the clinical utility of serum S100B as a marker of acute ischemic stroke and as a predictor of the infarct size, and to determine its relation to hs-CRP, as a marker of acute inflammation in such patients.
The study prospectively included 35 patients with first ever ischemic cerebrovascular stroke who were admitted to Ain Shams University Hospital within 24 hours from stroke onset, without any past history suggestive of brain lesion or any radiological evidence of previous cerebrovascular insult and they were matched with 20 healthy matched age and sex controls. All the patients were subjected to full clinical history taking, thorough clinical examination, CT and routine laboratory investigations. Two venous blood samples were taken. 1st sample was taken on 1st day of stroke onset and the 2nd sample was taken on 3rd day of stroke onset and assayed for random blood glucose, liver function tests, kidney function tests, serum hs-CRP and S100B.
In this study, serum S100B and hs- CRP levels were significantly higher in patients` group than in control group, as well as on 3rd day of stroke onset compared to 1st day of stroke onset. Moreover, only serum S100B levels were significantly higher in patients with large vessel infarction (more than 1.5 cm) than those with small vessel infarction. Furthermore, non significant correlation was detected between the two markers in patients group.
A certain cutoff of serum S100B and hs-CRP levels were chosen using ROC curve to determine their value in discriminating stroke patients from those of control. A cuttoff 90pg/mL and 2ng/ml for S100B and hs-CRP respectively, achieved sensitivities (91% &94%) and specificities (65%&90%)for S100B and hs-CRP respectively. Moreover, the combined use of S100B &hs-CRP in discriminating stroke patients from those of control using cutoff (80pg/mL & 2ng/mL for S100B &hs-CRP respectively) , improved the senitivity , specificity and diagnostic efficacy to be100%.
Furthermore, ROC curve analysis was done to discriminate stroke patients with large infarction from those with small infarction.A cuttoff of 170pg/mL and 3.8ng/mL for S100B&hs-CRP respectively, recorded sensitivities of (65% &59%) and specificities of (72%&50%)for S100B and hs-CRP respectively . In addition, the combined use of S100B &hs-CRP with cutoff (170pg/mL & 4.2ng/mL for S100B &hs-CRP respectively), improved the sensitivity, specificity and diagnostic efficacy reaching 94%, 95% and94%.
In conclusion, serum S100B & hs-CRP in patients with acute cerebrovascular stroke were found to be significantly elevated in the first 72 hours of diagnosis. Moreover, S100B levels in such patients were found to be increased with the increase in the infarct size. Finally, this study elucidated that S100B, as a marker of astrocyte damage, and hs-CRP, as a marker of inflammation can be introduced into the laboratory as novel and trusted diagnostic markers for early ischemic cerebrovascular stroke hand in hand with the conventional radiological parameters usually used to diagnose such patients, where combined use of both markers proved to be have more diagnostic efficiency than the use of either of them alone.