Neuron-specific enolase as a marker of cerebral tissue lesion in patients with ischemic stroke
Keywords:ischemic stroke, chronic brain ischemia, neuron-specific enolase, neurologic deficit, cognitive disorders
Background. A promising direction in modern angioneurology is the study of markers of brain tissue damage in the blood serum of patients in the acute period of ischemic stroke and their comparison with the initial level of neurologic deficit and stroke outcome. As a marker of brain tissue damage, the functions of neuron-specific enolase (NSE) are being actively studied. To evaluate the level of NSE in the acute period of ischemic stroke was the purpose of the work. Materials and methods. The clinical trial included 151 patients (mean age 61.5 ± 8.2 years), who were divided into 2 groups: group 1 consisted of 85 patients with acute ischemic stroke; group 2 — of 66 patients with chronic cerebral ischemia. Plasma NSE level was evaluated in all patients. We analyzed the correlations of NSE with the severity of neurologic deficit according to the National Institutes of Health Stroke Scale, functional activity — using Barthel index, the level of disability — on the modified Rankin scale, and the severity of cognitive impairment — according to the Mini-Mental State Examination. The relationships between the level of NSE and the survival of patients with ischemic stroke were determined. Results. In patients of group 1, the level of NSE exceeded that of the patients in group 2 by 3.8 times (p < 0.001). We established significant differences in the level of NSE depending on the location of the ischemic focus — involving the left middle cerebral artery and the vertebrobasilar bed (p = 0.04). In patients with severe neurologic deficit, NSE level exceeded that of patients with moderate and mild neurologic deficit by 1.3 (p = 0.251) and 2.3 (p = 0.007) times, respectively. A correlation was found between the level of NSE and the severity of neurologic deficit (r = 0.67, p = 0.027), which indicates a direct relationship between the degree of ischemic injury and neurological disorders. In patients with severe cognitive impairment, the level of NSE exceeded that of patients with moderate and mild cognitive impairment by 1.2 (p = 0.444) and 1.9 (p = 0.037) times, respectively. When assessing the relationship between the level of NSE and stroke outcome, a tendency to higher NSE was revealed in the group of deceased people (p = 0.083). The threshold NSE value in the blood of patients with ischemic stroke was determined — 40 ng/ml. Conclusions. Determination of NSE in plasma confirms the degree of damage to neurons and is an informative indicator for the presence of neurologic deficit in patients with acute ischemic stroke. The results indicate the potential role of evaluating the content of NSE in improving the stratification of the risk of death in patients with ischemic stroke.
Hankey G.J. Stroke. Lancet. 2016. DOI:https://doi.org/10.1016/S0140-6736(16)30962-X
Suslina Z.A., Gulevskaya T.S., Maksimova M.Yu., Morgunov V.A. Circulatory disorders: diagnosis, treatment, prevention. M.: MEDpress-inform, 2016. 536 р.
Yarosh A.S., Pirogova L.A., Filina N.A. The current state of the problem of acute cerebrovascular accident. Zhurn. Grodno State Medical University. 2014. Vol. 3. P. 17-20.
Suslina Z.A., Varakin Yu.Ya., Vereshchagin N.V. Clinical and epidemiological studies – a promising area for the study of cerebral pathology (first message). Annals of clinical and experimental neurology. 2009. Vol. 3. № 3. P. 4-11. https://annaly-nevrologii.com/journal/index.php/pathID/issue/view/36
Lopez A.D., Mathers C.D., Ezzati M. Global and regional burden of disease and risk factors, 2001: Systematic analysis of population health data. Lancet. 2006. Vol. 367. P. 1747-1757. DOI: 10.1016/S0140-6736(06)68770-9
Syskina E.N. Biochemical markers of the state of brain tissue and hemostasis in patients with severe forms of cerebral infarction in the arteries of the carotid system: author. dis. ... cand. med. sciences. 14.01.11 – «Nervous diseases», 03.01.04 – «Biochemistry». M., 2011. 24 p.
Shabalina A.A. Hemostasis and biochemical markers of brain tissue damage during atherothrombotic and lacunar subtypes of ischemic stroke: abstract. dis. ... cand. med. sciences. 14.00.13 – «Nervous diseases», 03.00.04 – «Biochemistry». M., 2008. 31 p.
Koh P.O. Proteomic analysis of focal cerebral ischemic injury in male rats. J. Vet. Med. Sci. 2010. Vol. 72, №2. Р. 181–185. DOI: 10.1292/jvms.09-0364
Whiteley W., Tseng M.C., Sandercock P. Blood biomarkers in the diagnosis of ischemic stroke. A sys-tematic review. Stroke. 2008. Vol. 39. P. 2902-2909. DOI: 10.1161/STROKEAHA.107.511261
Jauch E.C., Lindsell C., Broderick J. Association of serial biochemical markers with acute ischemic stroke. The National Institute of Neurological Disorders and Stroke recombinant tissue plasminogen activator stroke study. Stroke. 2006. Vol. 37. P. 2508-2513. DOI: 10.1161/01.STR.0000242290.01174.9e
Butterworth R.J., Wassif W.S., Sherwood R.A. Serum neuron-specific enolase, carnosinase, and their ratio in acute stroke. An enzymatic test for predicting outcome? Stroke. 1996. Vol. 27 (11). P. 2064-2068. DOI: 10.1161/01.str.27.11.2064
Zierath D., Thullbery M., Hadwin J. CNS immune responses following experimental stroke. Neurocrit Care. 2010. Vol. 12 (2). P. 274-284. DOI: 10.1007/s12028-009-9270-4
Pandey A., Saxena K., Verma M. Correlative study between neuron-specific enolase and blood sugar level in ischemic stroke patients. J. Neurosci. Rural. Pract. 2011. Vol. 2 (1). P. 50-54. DOI: 10.4103/0976-3147.80099
Nayak A.R., Badar S.R., Lande N. Prediction of outcome in diabetic acute ischemic stroke patients: a hospital-based pilot study report. Ann Neurosci. 2016. Vol. 23. P. 199-208. https://doi.org/10.1159/000449480
Rodrigues-Yaňez M., Castellanos M., Sobrino T. Interleukin-10 facilitates the selection of patients for systemic thrombolysis. BMC Neurol. 2013. Vol. 13. 62 р. DOI: 10.1186/1471-2377-13-62
Jung C.S., Lange B., Zimmermann M. CSF and serum biomarkers focusing on cerebral vasospasm and ischemia after subarachnoid hemorrhage. Stroke research and treatment. 2013. DOI: 10.1155/2013/560305
Alatas Ö.D., Gűrger M., Ateşcelik M. Neuron-specific enolase, S100 calcium-binding protein B, and heat shock protein 70 levels in patients with intracranial hemorrhage. Medicine. 2015. Vol. 94 (45). P. 1-5. DOI: 10.1097/MD.0000000000002007
Dementieva O.V., Starikova N.L. Clinical correlations of the indicator of neuron-specific enolase in patients with the first-ever ischemic stroke after systemic thrombolysis. Ural Medical Journal. 2017. Vol. 1 (145). S. 32-36.
Brouns R., De Vil B., Cras P. Neurobiochemical markers of brain damage in cerebrospinal fluid of acute ischemic stroke patients. Clinical Chemistry. 2010. Vol. 56 (3). P. 451-458. DOI: 10.1373/clinchem.2009.134122
Anand N., Stead L.G. Neuron-specific enolase as a marker for acute ischemic stroke: a systematic review. Cerebrovasc Dis. 2005. Vol. 20. P. 213–219. DOI: 10.1159/000087701
Bharosay A., Bharosay V.V., Varma M. Correlation of brain biomarker neuron specific enolase (NSE) with degree of disability and neurological worsening in cerebrovascular stroke. Ind. J. Clin. Biochem. 2012. Vol. 27 (2). P. 186–190. DOI: 10.1007/s12291-011-0172-9
Kawle A.P., Nayak A.R., Lande N.H. Comparative evaluation of risk factors, outcome and biomarkers levels in young and old acute ischemic stroke patients. Annals of Neurosciences. 2015. Vol. 22 (2). P. 70-77. DOI: 10.5214/ans.0972.7531.220204
Zaheer S., Beg M., Rizvi I. Correlation between serum neuron specific enolase and functional neurological outcome in patients of acute ischemic stroke. Ann Indian Acad Neurol. Vol. 16 (4). P. 504–508. DOI: 10.4103/0972-2327.120442
Gonzalez-Garcia S., Gonzalez-Quevedo A., Fernandez O. Concepcion Short-term prognostic value of serum neuron specific enolase and S100B in acute stroke patients. Clin. Biochem. 2012. Vol. 45. P. 1302–1307. DOI: 10.1016/j.clinbiochem.2012.07.094
Belova A.N. Scales, tests and questionnaires in neurology and neurosurgery. A guide for doctors. Moscow: Medkniga, 2004. 456 р.
Toropova N.E., Dorofeeva E.A., Dvoryaninova S.P., Vasieva J.P. Assessment of the information content of a neuron-specific enolase determined by the enzyme immunoassay. Clinic. lab. diagnostics. 1995. Vol. 1. Р. 15-17.
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