From the *Department of Pediatrics; †Department of Biochemistry; ‡Department of Microbiology; §Department of Cardiology, Cumhuriyet University Faculty of Medicine, Sivas, Turkey; and ¶Department of Pharmaceutical Microbiology, Cumhuriyet University Faculty of Pharmacy, Sivas, Turkey.
Pediatr Infect Dis J. 2015 Feb;34(2):208-13. doi: 10.1097/INF.0000000000000530.
Apoptosis is a main regulator in responses of cellular immunity throughout systemic viral infections. Perforin, soluble Fas ligand, caspase-3 and caspase-cleaved cytokeratin-18 (M-30) are mediators of apoptosis. The aim of this study is the evaluation of Crimean-Congo hemorrhagic fever (CCHF) disease changes in the levels of these apoptotic markers and the relation of these changes with disease severity.
Forty-nine hospitalized children with CCHF and 36 healthy controls were enrolled in this prospective study. The CCHF patients were classified into 2 groups based on disease severity (severe group and nonsevere group). Demographic characteristics and clinical and laboratory findings of all patients were recorded on admission.
Serum perforin, caspase-3 and soluble Fas ligand levels were found to be significantly higher both in the severe and nonsevere CCHF groups than the healthy control group (P < 0.05), but there was no significant difference in these apoptotic markers between severe and nonsevere CCHF groups (P > 0.05). In addition, serum M-30 levels did not differ significantly among all groups (P > 0.05). There was a positive correlation between serum values for perforin, caspase-3 and M-30 and the disease's severity criteria such as aspartate aminotransferase and/or alanine aminotransferase. The serum levels of all these markers were negatively correlated with disease severity criteria such as the platelet count.
In this study, we concluded that the interactions of cytolytic granules containing perforin and caspase cascade and Fas-FasL may play an important role in the pathogenesis of CCHF in children.
细胞凋亡是细胞免疫对全身病毒感染反应的主要调节因子。穿孔素、可溶性 Fas 配体、半胱天冬酶-3 和半胱天冬酶切割细胞角蛋白-18（M-30）是凋亡的介质。本研究的目的是评估克里米亚-刚果出血热（CCHF）疾病中这些凋亡标志物水平的变化及其与疾病严重程度的关系。
本前瞻性研究纳入了 49 例住院的 CCHF 患儿和 36 名健康对照者。根据疾病严重程度（严重组和非严重组）将 CCHF 患者分为 2 组。所有患者入院时均记录人口统计学特征、临床和实验室发现。
血清穿孔素、半胱天冬酶-3 和可溶性 Fas 配体水平在严重和非严重 CCHF 组中均显著高于健康对照组（P<0.05），但严重和非严重 CCHF 组之间这些凋亡标志物无显著差异（P>0.05）。此外，所有组之间的血清 M-30 水平无显著差异（P>0.05）。血清穿孔素、半胱天冬酶-3 和 M-30 值与天冬氨酸氨基转移酶和/或丙氨酸氨基转移酶等疾病严重程度标准呈正相关。这些标志物的血清水平与血小板计数等疾病严重程度标准呈负相关。
在本研究中，我们得出结论，包含穿孔素和胱天冬酶级联和 Fas-FasL 的细胞溶酶体的相互作用可能在儿童 CCHF 的发病机制中起重要作用。
