Kafa travmalı hastalarda beyin omurilik sıvısı, B-endorfin, serotonin, substance P ve lipid peroksidasyonu seviyelerinin incelenmesi

Abstract

77 8. SUMMARY The cerebrospinal fluid (CSF) levels of P-endorphin ((3-end), serotonin (5-HT), Substance P (SP) and lipid peroxidation (Lpx) products were measured in 45 patients (31 Male/ 14 Female, aged 19.02 ± 17.79 years) with traumatic head injury, admitted to the Neurosurgery Clinic of the Erciyes University, Medical Faculty. Lumbar CSF samples were collected within 24 hours following the head trauma. The CSF samples obtained from 25 healthy subjects (23 Male/ 2 Female, aged 51.44± 17.6 years) having minor surgical operations under spinal anaesthesia, were included as the controls. Patients with head injury were evaluated according to their Glasgow Coma Scale (GCS) scores on admission and four subgroups were formed as follows: Group I: minor head trauma (GCS:13-15) without skull fracture; Group II: mild head trauma (GCS: 13-1 5) with skull fracture; Group III: moderate head injury (GCS: 8-12) and Group IV: severe head injury (GCS: <8). All patients with head injury had significantly higher CSF p-end levels than the controls (p<0.001). The levels of 3-end in patients with minor head injury (Group II) were significantly higher than those in patients with severe head trauma (Group IV) (p< 0.001). The Lpx levels were also significantly increased in all head injury patients (p<0.001), but there was no significant difference between the patient subgroups.78 Significant decreases were found in both 5-HT (p<0.001) and SP levels (p< 0.005) in patients with head injury. AH of the patient subgroups also had significantly lower 5-HT leves than the controls (p<0.001) and the levels in Group II were significantly lower than the levels in Group IV (p< 0.005). When the SP levels in each patient subgroup were compared to the levels in controls, SP levels in Group I and Group IV were significantly decreased (p< 0.005), while the levels in Group II and Group III were not changed. Also, the patients in Group I and Grup IV had significantly lower SP levels than the patients in Grup III (p<0.05 and p<0.005 respectively). There was not any direct correlation between CSF changes and the GCS scores of the patients. Endogenous neuropeptides (e.g. p-end and SP), monoaminergic neurotransmitters (e.g. serotonin) and lipid peroxidation are all suggested to have a role in central nervous system (CNS) injuries. However, the studies in the literature with regard to the CSF levels of p-end, SP, serotonin and Lpx in patients with traumatic head injury are extremely limited. In the present study, significant changes in CSF p-end, SP, serotonin and Lpx levels are found in patients with a wide range of head trauma (from minor head injury to severe trauma). And the possible roles of these changes in the pathophysiology of traumatic head injury are discussed with the scope of the previous findings in the literature.

77 8. SUMMARY The cerebrospinal fluid (CSF) levels of P-endorphin ((3-end), serotonin (5-HT), Substance P (SP) and lipid peroxidation (Lpx) products were measured in 45 patients (31 Male/ 14 Female, aged 19.02 ± 17.79 years) with traumatic head injury, admitted to the Neurosurgery Clinic of the Erciyes University, Medical Faculty. Lumbar CSF samples were collected within 24 hours following the head trauma. The CSF samples obtained from 25 healthy subjects (23 Male/ 2 Female, aged 51.44± 17.6 years) having minor surgical operations under spinal anaesthesia, were included as the controls. Patients with head injury were evaluated according to their Glasgow Coma Scale (GCS) scores on admission and four subgroups were formed as follows: Group I: minor head trauma (GCS:13-15) without skull fracture; Group II: mild head trauma (GCS: 13-1 5) with skull fracture; Group III: moderate head injury (GCS: 8-12) and Group IV: severe head injury (GCS: <8). All patients with head injury had significantly higher CSF p-end levels than the controls (p<0.001). The levels of 3-end in patients with minor head injury (Group II) were significantly higher than those in patients with severe head trauma (Group IV) (p< 0.001). The Lpx levels were also significantly increased in all head injury patients (p<0.001), but there was no significant difference between the patient subgroups.78 Significant decreases were found in both 5-HT (p<0.001) and SP levels (p< 0.005) in patients with head injury. AH of the patient subgroups also had significantly lower 5-HT leves than the controls (p<0.001) and the levels in Group II were significantly lower than the levels in Group IV (p< 0.005). When the SP levels in each patient subgroup were compared to the levels in controls, SP levels in Group I and Group IV were significantly decreased (p< 0.005), while the levels in Group II and Group III were not changed. Also, the patients in Group I and Grup IV had significantly lower SP levels than the patients in Grup III (p<0.05 and p<0.005 respectively). There was not any direct correlation between CSF changes and the GCS scores of the patients. Endogenous neuropeptides (e.g. p-end and SP), monoaminergic neurotransmitters (e.g. serotonin) and lipid peroxidation are all suggested to have a role in central nervous system (CNS) injuries. However, the studies in the literature with regard to the CSF levels of p-end, SP, serotonin and Lpx in patients with traumatic head injury are extremely limited. In the present study, significant changes in CSF p-end, SP, serotonin and Lpx levels are found in patients with a wide range of head trauma (from minor head injury to severe trauma). And the possible roles of these changes in the pathophysiology of traumatic head injury are discussed with the scope of the previous findings in the literature.