{"id":529,"date":"2022-01-27T09:10:21","date_gmt":"2022-01-27T06:10:21","guid":{"rendered":"https:\/\/tatd.org.tr\/travma\/?p=529"},"modified":"2022-02-23T16:47:24","modified_gmt":"2022-02-23T13:47:24","slug":"travmatik-beyin-hasarinda-markerlar","status":"publish","type":"post","link":"https:\/\/tatd.org.tr\/travma\/genel\/travmatik-beyin-hasarinda-markerlar\/","title":{"rendered":"Travmatik Beyin Hasar\u0131nda Markerlar"},"content":{"rendered":"<p>Merhaba, bu yaz\u0131m\u0131zda hafif travmatik beyin hasar\u0131 durumunda sonlan\u0131m\u0131 \u00f6ng\u00f6rme ve uzun vadede tedavi stratejileri olu\u015fturmak a\u00e7\u0131s\u0131ndan faydal\u0131 olabilecek markerlarla ilgili bir derlemeden bahsedece\u011fiz. \u00d6zellikle klinik ara\u015ft\u0131rma yapmak isteyen ya da tez konusu a\u00e7\u0131s\u0131ndan ilham arayanlar i\u00e7in g\u00fczel bir kaynak olmas\u0131n\u0131 diliyorum. Derlemenin orijinaline <a href=\"https:\/\/doi.org\/10.1016\/j.mcn.2015.02.003\">buradan<\/a> ula\u015fabilirsiniz.<\/p>\n<h4>Giri\u015f<\/h4>\n<ul>\n<li>\u0130ntrakranial kanama ve\/veya kitlesel lezyonla sonu\u00e7lanan orta-ciddi travmatik beyin hasar\u0131 (TBH) klinisyenler taraf\u0131ndan hem muayene ve hem de standart g\u00f6r\u00fcnt\u00fcleme y\u00f6ntemleri ile tan\u0131s\u0131 konabilen durumlard\u0131r.<\/li>\n<li>Ancak hafif TBH ya da konk\u00fczyonu tespit etmesi, tan\u0131 koymas\u0131 daha zordur. Konk\u00fczyon durumunda tomografide , kanama gibi belirgin bir patoloji g\u00f6r\u00fclmemektedir.<\/li>\n<li>Birka\u00e7 g\u00fcnden haftaya kadar spontan olarak normale d\u00f6nen ve h\u0131zl\u0131 ba\u015flang\u0131\u00e7l\u0131 bir n\u00f6ronal disfonksiyon ile kar\u015f\u0131la\u015fabilmekteyiz ve bu durumun sebeplerinden biri aksonlar\u0131n ve santral sinir sistemindeki (SSS) di\u011fer yap\u0131lar\u0131n maruz kald\u0131\u011f\u0131 direkt hasard\u0131r ve tan\u0131s\u0131n\u0131 koymak \u00e7ok \u00f6nemlidir.<\/li>\n<\/ul>\n<h4>Hafif TBH \/ Konk\u00fczyon<\/h4>\n<ul>\n<li>Konk\u00fczyon g\u00f6r\u00fclen hastalar\u0131n yakla\u015f\u0131k %15\u2019inde kognitif bozukluklar travma sonras\u0131 devam etmektedir ve bunun en \u00f6nemli nedeni\u00a0 diff\u00fcz aksonal hasard\u0131r.<\/li>\n<li>Ayr\u0131ca tekrarlayan konk\u00fczyonlar\u0131n; boks\u00f6rler ve askerler gibi kronik travmaya maruz kalan meslek gruplar\u0131nda g\u00f6r\u00fclebilen kronik ve ilerleyici olan, n\u00f6rolojik ve\/veya psikiyatrik semptomlarla karakterize olan kronik travmatik ensefalopati (KTE) riskini artt\u0131rd\u0131\u011f\u0131 da g\u00f6sterilmi\u015ftir.<\/li>\n<li>Radyolojik tan\u0131 koyman\u0131n zor oldu\u011fu durumlarda ek belirte\u00e7lere gereksinim vard\u0131r. N\u00f6ronal, aksonal ve astroglial hasarlar\u0131 g\u00f6steren\u00a0 markerlar; kafa travmas\u0131 ile ba\u015fvuran hastalarda konk\u00fczyon tan\u0131s\u0131 koymak, k\u0131sa -uzun d\u00f6nem sonlan\u0131mlar\u0131n\u0131 \u00f6ng\u00f6rmek ve \u00a0TBH tan\u0131s\u0131n\u0131 atlat\u0131p atlatamad\u0131\u011f\u0131n\u0131 anlamak a\u00e7\u0131s\u0131ndan de\u011ferli olabilecek parametrelerdir.<\/li>\n<\/ul>\n<h4>Hangi v\u00fccut s\u0131v\u0131lar\u0131 ile \u00e7al\u0131\u015fabiliriz?<\/h4>\n<h5>Beyin-omurilik s\u0131v\u0131s\u0131 (BOS)<\/h5>\n<p>BOS; beyni saran,mekanik destek sa\u011flayan, n\u00f6ronlara sinyal molek\u00fcllerini ta\u015f\u0131y\u0131p, at\u0131k metabolitlerden kurtulmaya yard\u0131mc\u0131 bir s\u0131v\u0131d\u0131r.<\/p>\n<p>Beynin interstisyel s\u0131v\u0131s\u0131 ile s\u00fcrekli temas halinde oldu\u011fu i\u00e7in biyokimyasal de\u011fi\u015fiklikler BOS\u2019 a direkt olarak yans\u0131maktad\u0131r. BOS\u2019 un d\u00fc\u015f\u00fck proteaz aktivitesine sahip olmas\u0131 ve tan\u0131ya yard\u0131mc\u0131 bir \u00e7ok molek\u00fcl\u00fcn \u00f6rnekleme s\u0131ras\u0131nda bozulmamas\u0131 avantajlar\u0131 aras\u0131nda . BOS \u00f6rneklemesinin dezavantaj\u0131 ise invaziv olu\u015fudur.<\/p>\n<h5>Kan<\/h5>\n<p>Kan veya komponentleri (serum veya plazma) kullan\u0131labilecek\u00a0 \u00f6nemli \u201cbios\u0131v\u0131\u201d d\u0131r.<\/p>\n<p>BOS\u2019 a g\u00f6re elde etmesi daha kolayd\u0131r ancak SSS\u2019 ine \u00f6zg\u00fc bir \u00e7ok marker kanda \u00e7ok d\u00fc\u015f\u00fck konsantrasyonlarda bulundu\u011fu i\u00e7in \u00f6l\u00e7\u00fcm zorla\u015fmaktad\u0131r.<\/p>\n<h5>T\u00fck\u00fcr\u00fck, idrar, g\u00f6zya\u015f\u0131<\/h5>\n<p>SSS\u2019 e \u00f6zg\u00fc protein Tau , Parkinson ili\u015fkili \u03b1-synuclein ve DJ-1 gibi proteinlerin t\u00fck\u00fcr\u00fckte salg\u0131land\u0131\u011f\u0131n\u0131 g\u00f6steren \u00e7al\u0131\u015fmalar mevcuttur <sup>1,2<\/sup>.<\/p>\n<p>Ancak t\u00fck\u00fcr\u00fck konsantrasyonlar\u0131 ve SSS konsantrasyonlar\u0131 aras\u0131nda ba\u011flant\u0131ya ve oranlara dair net bir veri ve \u00e7al\u0131\u015fma bulunmamaktad\u0131r .<\/p>\n<h4>Akut Hafif Travmatik Beyin Hasar\u0131nda Kullan\u0131lmaya Aday Markerlar<\/h4>\n<ul>\n<li>Derlemenin inceledi\u011fi makalelere g\u00f6re; konk\u00fczyonda aksonal hasar BOS\u2019 ta, intra-aksonal proteinler olan <strong>neurofilamentlight (NF-L)<\/strong> ve <strong>Tau<\/strong> seviyelerine bak\u0131larak tan\u0131mlan\u0131p takip edilebilir<sup>3,4<\/sup>. (Tablo 1)<\/li>\n<li>NF-L, \u00f6zellikle subkortikal derin beyin katmanlar\u0131na kadar ilerleyen geni\u015f \u00e7apl\u0131 myelinize aksonlardan sal\u0131nan bir yap\u0131sal proteindir ve kafaya al\u0131nan bir darbe sonucunda artt\u0131\u011f\u0131 g\u00f6sterilmi\u015ftir.<\/li>\n<li>Yap\u0131lan baz\u0131 \u00e7al\u0131\u015fmalarda boks ma\u00e7lar\u0131 sonras\u0131nda kafaya al\u0131nan darbe say\u0131s\u0131 ile BOS\u2019 taki NF-L konsantrasyonlar\u0131n\u0131n korele oldu\u011fu g\u00f6sterilmi\u015ftir<sup>3,4<\/sup>.<\/li>\n<li>Yak\u0131n zamanl\u0131 bir olgu bildiriminde nakavt olmu\u015f bir amat\u00f6r boks\u00f6rdeki BOS NF-L seviyesinin normale d\u00f6nmesinin 8 ay ald\u0131\u011f\u0131 g\u00f6sterilmi\u015f<sup>5<\/sup>.<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<div class=\"pcrstb-wrap\"><table>\n<caption><strong>Tablo 1. Akut Hafif Travmatik Beyin Hasar\u0131nda Kullan\u0131lmaya Aday Markerlar<\/strong><\/caption>\n<tbody>\n<tr>\n<td width=\"302\"><strong>Biomarker<\/strong><\/td>\n<td width=\"302\"><strong>Kaynak<\/strong><\/td>\n<\/tr>\n<tr>\n<td width=\"302\"><strong>Neurofilamentlight (NF-L)<\/strong><\/td>\n<td width=\"302\">Geni\u015f \u00e7apl\u0131 aksonlarda olu\u015fturulan intra-aksonal yap\u0131sal bir protein<\/td>\n<\/tr>\n<tr>\n<td width=\"302\"><strong>Tau<\/strong><\/td>\n<td width=\"302\">\u0130nce ,myelinsiz aksonlarda olu\u015fturulan bir intra-aksonal yap\u0131sal protein<\/td>\n<\/tr>\n<tr>\n<td width=\"302\"><strong>\u03b1-Spectrin N-terminal fragment<\/strong><\/p>\n<p><strong>(SNTF)<\/strong><\/td>\n<td width=\"302\">Kalsiyum ba\u011f\u0131ml\u0131 proteaz olan kalpain taraf\u0131ndan olu\u015fturulan\u00a0 aksonal hasar marker\u0131<\/td>\n<\/tr>\n<tr>\n<td width=\"302\"><strong>Neuron-specificenolase (NSE)<\/strong><\/td>\n<td width=\"302\">N\u00f6ronal soma ve kan h\u00fccrelerinde de sal\u0131nan bir protein<\/td>\n<\/tr>\n<tr>\n<td width=\"302\"><strong>Ubiquitin C-terminal hydrolase<\/strong><\/p>\n<p><strong>L1 (UCHL1)<\/strong><\/td>\n<td width=\"302\">N\u00f6ron, gonad ve akci\u011fer dokusunda sal\u0131nan bir protien<\/td>\n<\/tr>\n<tr>\n<td width=\"302\"><strong>S100B<\/strong><\/td>\n<td width=\"302\">SSSde \u00e7ok\u00e7a bulunan bir astroglial protein<\/td>\n<\/tr>\n<tr>\n<td width=\"302\"><strong>Glialfibrillaryacidic protein (GFAP)<\/strong><\/td>\n<td width=\"302\">SSS spesifik astroglial protein<\/td>\n<\/tr>\n<\/tbody>\n<\/table><\/div>\n<h5>Kan markerlar\u0131<\/h5>\n<p>Tau d\u00fczeyi ve beyin hasar\u0131na \u00a0y\u00f6nelik yap\u0131lan \u00e7al\u0131\u015fmalar gelecek vadeden sonu\u00e7lar i\u00e7ermekte:<\/p>\n<ol>\n<li>Serum Tau seviyeleri ve res\u00fcsite edilen kardiyak arrest hastalar\u0131nda n\u00f6rolojik sonlan\u0131m ile ilgili g\u00fc\u00e7l\u00fc bir korelasyon vard\u0131r<sup>6<\/sup>.<\/li>\n<li>Olimpik b\u00f6ks\u00f6rlerde plazma Tau konsantrasyonlar\u0131 y\u00fcksek bulunmu\u015ftur<sup>7<\/sup>.<\/li>\n<li>Alzheimer hastalar\u0131nda plazma Tau konsantrasyonlar\u0131 y\u00fcksek bulunmu\u015ftur<sup>8<\/sup>.<\/li>\n<li>Konk\u00fczyon g\u00f6r\u00fclen buz hokeyi oyuncular\u0131nda,travmadan 1 saat sonra bak\u0131lan plazma Tau konsantrasyonlar\u0131 d\u00fczeyi ile \u00a0oyuncular\u0131n semptomlar\u0131n\u0131n ge\u00e7mesi i\u00e7in gerek g\u00fcn say\u0131s\u0131 aras\u0131nda do\u011fru orant\u0131l\u0131 bir ili\u015fki g\u00f6sterilmi\u015ftir<sup>9<\/sup>. Tau d\u00fczeyi artt\u0131k\u00e7a TBH s\u00fcresi ve uzunlu\u011fu artmaktad\u0131r.<\/li>\n<\/ol>\n<p>&nbsp;<\/p>\n<ul>\n<li>Ancak BOS\u2019 taki ve plazmadaki Tau seviyeleri korele de\u011fildir<sup>8<\/sup> ve akut beyin hasar\u0131 sonras\u0131nda Tau seviyesi BOS\u2019 ta haftalarca y\u00fcksek kal\u0131rken kanda g\u00fcnler i\u00e7inde normale d\u00f6nmektedir<sup>10,11<\/sup>.<\/li>\n<li>Bir ba\u015fka marker ise SNTF olarak g\u00f6sterilmi\u015ftir. Normalde sa\u011fl\u0131kl\u0131 aksonlarda tespit edilemeyen SNTF, gerilme mekanizmas\u0131 ile olu\u015fan hasarlarda proteaz enzimi ile olu\u015fmaktad\u0131r. Proteaz kalsiyum taraf\u0131ndan aktive edilen bir enzimdir ve \u00a0kalpain arac\u0131l\u0131\u011f\u0131yla spektrin molek\u00fcl\u00fcn\u00fcn proteolizisi\u00a0 ile olu\u015fmaktad\u0131r <sup>12<\/sup> . BT- negatif hafif TBH dahil durumlarda bile kanda \u00f6l\u00e7\u00fclebilecek derecede SNTF art\u0131\u015f\u0131 g\u00f6r\u00fclmesi \u00a0olmas\u0131 bu marker\u0131 tan\u0131sal olarak de\u011ferli k\u0131lmaktad\u0131r<sup>13<\/sup>\u00a0ancak klinik olarak anlaml\u0131 oldu\u011funa dair kuvvetli kan\u0131tlar hen\u00fcz yoktur.<\/li>\n<li>Di\u011fer marker adaylar\u0131 ise <strong>neuron-specificenolase (NSE), ubiquitin C-terminal hydrolase L1(UCHL1), S100B <\/strong>ve<strong> glial fibrillary acidic protein (GFAP) <\/strong><sup>14<\/sup>.<\/li>\n<li>Tau ve SNTF\u2019nin aksine bu markerlar\u0131n hi\u00e7birinde, \u00a0negatif beyin tomografisi \u00a0olan konk\u00fczyon tan\u0131l\u0131 hastalar\u0131n \u00a0sonlan\u0131m\u0131yla ilgili prognostik ili\u015fkiyi saptamada tan\u0131sal yeri yoktur<sup>14<\/sup>.<\/li>\n<\/ul>\n<h4>Kronik travmatik ensefalopati<\/h4>\n<ul>\n<li>Kronik Travmatik Ensefalopati (KTE) tan\u0131m olarak \u00a0tekrarlayan kafa travmalar\u0131 ile ili\u015fkili bio-n\u00f6ro-dejeneratif hastal\u0131kt\u0131r.<\/li>\n<li>Ba\u015flang\u0131\u00e7ta sadece boks\u00f6rleri etkiledi\u011fi d\u00fc\u015f\u00fcn\u00fclse de Amerikan futbolcular\u0131,hokey oyuncular\u0131, g\u00fcre\u015f\u00e7ileri, askerleri de i\u00e7ine alacak \u015fekilde riskli grup pop\u00fclasyonu gittik\u00e7e geni\u015flemektedir.<\/li>\n<li>\u0130lerlemi\u015f KTE\u2019de gross morfolojik de\u011fi\u015fiklikleri g\u00f6rmek i\u00e7in standart n\u00f6ro-g\u00f6r\u00fcnt\u00fcleme y\u00f6ntemleri kullan\u0131labilecek olsa da standardize edilmi\u015f bir g\u00f6r\u00fcnt\u00fcleme sistemi ya da marker\u0131 yoktur.<\/li>\n<li>Yap\u0131lan bir \u00e7al\u0131\u015fmada be\u015f eski futbol oyuncusu ve konk\u00fczyon \u00f6yk\u00fcs\u00fc olmayan be\u015f hastada beyin Tau miktar\u0131 pozitron emisyon tomografi (PET) ile taranm\u0131\u015f ve eski futbolcu grubunda daha y\u00fcksek Tau birikim sinyali saptanm\u0131\u015f<sup>15<\/sup>.<\/li>\n<li>\u015eimdilik markerlar konusunda klinikte kullan\u0131m a\u00e7\u0131s\u0131ndan yeterli veri bulunmamaktad\u0131r ve \u00e7al\u0131\u015fmalar ile desteklenmeye gerek vard\u0131r.<\/li>\n<\/ul>\n<h4>Hafif TBH\/ konk\u00fczyon markerlar\u0131 KTE tablosunu engellemede yard\u0131mc\u0131 olabilir mi?<\/h4>\n<ul>\n<li>TBH\u2019 \u0131nda biomarker ara\u015ft\u0131rmalar\u0131n\u0131n as\u0131l amac\u0131 zaten hali haz\u0131rda mevcut olan, orta-ciddi beyin hasar\u0131n\u0131n tan\u0131s\u0131 i\u00e7in y\u00f6ntem geli\u015ftirmekten ziyade hafif TBH\/ konk\u00fczyonda molek\u00fcler de\u011fi\u015fiklikleri g\u00f6stererek darbe nedenli bir hasar\u0131n olup olmad\u0131\u011f\u0131n\u0131 ve iyile\u015fme s\u00fcrecini g\u00f6zlemlemek.<\/li>\n<li>B\u00f6ylece hafif hasara maruz kalanlar\u0131n hasar \u015fiddetinin ilerlemesi de engellenecektir.<\/li>\n<li>Ek olarak tedavi s\u00fcrecinin tamamlan\u0131p tamamlanmad\u0131\u011f\u0131n\u0131 biyomarkerlar objektif bir test kullanarak g\u00f6sterip gerekirse rehabilitasyon s\u00fcrecini uzatma karar\u0131n\u0131 da almaya yard\u0131m edebilir.<\/li>\n<\/ul>\n<h4>Sonu\u00e7 olarak..<\/h4>\n<p>\u00d6zetle travmatik beyin hasar\u0131 i\u00e7in gelecek vadeden\u00a0 BOS ve kan marker\u0131 mevcuttur. Potansiyel prediktif de\u011ferlerine y\u00f6nelik \u00e7al\u0131\u015fmalar yap\u0131larak klinik a\u00e7\u0131dan hasar\u0131n sonlan\u0131m kararlar\u0131n\u0131 almaya \u00a0ve tedavi stratejilerinin bu a\u00e7\u0131dan \u015fekillendirmeye yard\u0131mc\u0131 \u00a0k\u0131lavuz olu\u015fturmas\u0131 sa\u011flanabilir.<\/p>\n<p><strong>Yazar :<\/strong> Dr. \u00d6zgecan G\u00f6rman<\/p>\n<p><strong>Edit\u00f6r :<\/strong> Prof. Dr. Arzu Denizba\u015f\u0131<\/p>\n<hr \/>\n<p><strong>Kaynaklar<\/strong><\/p>\n<ol>\n<li>Shi, M., Sui, Y.T., Peskind, E.R., Li, G., Hwang, H., Devic, I., Ginghina, C., Edgar, J.S., Pan, C.,<br \/>\nGoodlett, D.R., Furay, A.R., Gonzalez-Cuyar, L.F., Zhang, J., 2011. Salivary tau species<br \/>\nare potential biomarkers of Alzheimer&#8217;s disease. J. 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Psychiatry 21, 138\u2013144.<\/li>\n<\/ol>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Merhaba, bu yaz\u0131m\u0131zda hafif travmatik beyin hasar\u0131 durumunda sonlan\u0131m\u0131 \u00f6ng\u00f6rme ve uzun vadede tedavi stratejileri olu\u015fturmak a\u00e7\u0131s\u0131ndan faydal\u0131 olabilecek markerlarla ilgili bir&hellip;<\/p>\n","protected":false},"author":3162,"featured_media":532,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"inline_featured_image":false,"_lmt_disableupdate":"","_lmt_disable":"","footnotes":""},"categories":[1,10014],"tags":[10074,10070,10073,10075,10071,10076,10046,10069],"class_list":["post-529","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-genel","category-akademik-blog-yazisi","tag-biyomarker","tag-hafif-travmatik-beyin-hasari","tag-kafa-travmasi","tag-konkuzyon","tag-nse","tag-tau","tag-travma","tag-travmatik-beyin-hasari"],"acf":[],"_links":{"self":[{"href":"https:\/\/tatd.org.tr\/travma\/wp-json\/wp\/v2\/posts\/529","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/tatd.org.tr\/travma\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/tatd.org.tr\/travma\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/tatd.org.tr\/travma\/wp-json\/wp\/v2\/users\/3162"}],"replies":[{"embeddable":true,"href":"https:\/\/tatd.org.tr\/travma\/wp-json\/wp\/v2\/comments?post=529"}],"version-history":[{"count":0,"href":"https:\/\/tatd.org.tr\/travma\/wp-json\/wp\/v2\/posts\/529\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/tatd.org.tr\/travma\/wp-json\/wp\/v2\/media\/532"}],"wp:attachment":[{"href":"https:\/\/tatd.org.tr\/travma\/wp-json\/wp\/v2\/media?parent=529"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/tatd.org.tr\/travma\/wp-json\/wp\/v2\/categories?post=529"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/tatd.org.tr\/travma\/wp-json\/wp\/v2\/tags?post=529"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}