Meki Abdel-Raheim A M, Hasan Hosney A, El-Deen Zeinab M Mohey, Bakkar Saly
Department of Biochemistry, Faculty of Medicine, Assiut University, Assiut, Egypt.
Toxicon. 2003 Sep;42(3):229-37. doi: 10.1016/s0041-0101(03)00128-4.
In the present study, 46 children in Upper Egypt (less than 13 years old) were admitted to the Pediatric Intensive Care Unit for scorpion envenomation. They were compared with 20 apparently healthy children of matching age and sex as controls. Out of the studied victims, 25 children (54%) showed signs of severe envenomation and multiple organ dysfunction (MOD), while 21 victims (46%) showed signs of mild envenomation. The serum levels of apoptotic markers, soluble Fas (sFas), soluble Fas ligand (sFasL) and Bcl-2, were determined for both victims and controls. In addition, the serum levels of nitric oxide (NO) and lipid peroxides (LPO) were also measured. Scoring of MOD was evaluated using Logistic Organ Dysfunction System Score (LODS) for the severely envenomed victims. All victims (both severe and mild cases) showed significantly higher mean levels of sFas, LPO and NO and significantly lower serum levels of Bcl-2 in comparison to the controls. The level of sFasL was not detectable in the sera of the healthy control group. The case fatality rate was 15%. The severely envenomed children with MOD as well as the non-survivors showed significantly higher serum levels of sFas, sFasL, LPO and NO and significantly lower serum levels of Bcl-2 in comparison to the mild envenomed victims and the surviving victims of severe cases, respectively. The LODS score of the severely envenomed victims showed significant positive correlations with sFas and LPO and significant negative correlation with Bcl-2. In all victims, a significant positive correlation was detected between sFas and NO. On the other hand, Bcl-2 was significantly negatively correlated with both sFas and LPO. In conclusion, our study revealed that scorpion envenomation can increase apoptosis as shown by up-regulation of sFas/sFasL system and down-regulation of Bcl-2 that was associated by elevation of LPO and NO. This dysregulation of apoptosis was increased with the severity of scorpion envenomation and its extent increased as MOD score and outcome increased. Therefore, sFas and Bcl-2 may be of value in predicting the outcome of these cases. The increase of the extent of apoptosis detected in this study seems to play a role in the outcome of scorpion envenomation, and hence, should be taken into consideration for strategies of therapeutic regimen.
在本研究中，46名上埃及地区（年龄小于13岁）的儿童因蝎子蜇伤被收治入儿科重症监护病房。他们与20名年龄和性别匹配的明显健康儿童作为对照进行比较。在研究的受害者中，25名儿童（54%）表现出严重蜇伤和多器官功能障碍（MOD）的迹象，而21名受害者（46%）表现出轻度蜇伤的迹象。测定了受害者和对照组的凋亡标志物血清水平，包括可溶性Fas（sFas）、可溶性Fas配体（sFasL）和Bcl-2。此外，还测量了一氧化氮（NO）和脂质过氧化物（LPO）的血清水平。使用逻辑器官功能障碍系统评分（LODS）对严重蜇伤的受害者进行MOD评分评估。与对照组相比，所有受害者（包括重症和轻症病例）的sFas、LPO和NO平均水平均显著升高，而血清Bcl-2水平显著降低。健康对照组血清中未检测到sFasL水平。病死率为15%。与轻度蜇伤的受害者和重症病例的存活受害者相比，患有MOD的严重蜇伤儿童以及非存活者的血清sFas、sFasL、LPO和NO水平分别显著升高，而血清Bcl-2水平显著降低。严重蜇伤受害者的LODS评分与sFas和LPO呈显著正相关，与Bcl-2呈显著负相关。在所有受害者中，sFas与NO之间检测到显著正相关。另一方面，Bcl-2与sFas和LPO均呈显著负相关。总之，我们的研究表明，蝎子蜇伤可导致凋亡增加，表现为sFas/sFasL系统上调和Bcl-2下调，并与LPO和NO升高相关。这种凋亡失调随着蝎子蜇伤的严重程度增加而加剧，其程度随着MOD评分和预后的增加而增加。因此，sFas和Bcl-2可能对预测这些病例的预后有价值。本研究中检测到的凋亡程度增加似乎在蝎子蜇伤的预后中起作用，因此，在治疗方案策略中应予以考虑。
