El-DeeK Sahar E M, Sayed Ayat A, Nassar Ahmed Y, Mohey-Eldeen Zeynab M, Eldeeb Hussein M, Meki Abdel-Raheim M A
Medical Biochemistry, Faculty of Medicine, Assiut University, Assiut, Egypt.
Pediatric Departments, Faculty of Medicine, Assiut University, Assiut, Egypt.
Toxicon. 2017 Mar 1;127:77-84. doi: 10.1016/j.toxicon.2017.01.006. Epub 2017 Jan 11.
Scorpion envenomation causes an autonomic storm resulting in changes in the vasoactive mediators' levels which lead to myocardial damage, cardiovascular disturbances, peripheral circulatory failure, pulmonary edema, multi-system-organ-failure and death. The study aimed to determine the circulating levels of adrenaline, noradrenaline, angiotensin converting enzyme (ACE), Angiotensin II (Ang II), kallikrein enzyme, nitric oxide (NO), aldosterone, and electrolytes Na, K and Ca in scorpion envenomed children and to evaluate the potential relation between these vasoactive mediators, the severity of scorpion envenoming and the clinical outcome of envenomed children. Forty envenomed children (22 mild and 18 severe cases) along with 10 healthy control children were enrolled in the study. The circulating levels of adrenaline, noradrenaline, Ang II, ACE, kallikrein enzyme, and NO were determined by ELISA, and spectrophotometric assays on admission and 24 h later. On admission, serum aldosterone, and electrolytes; Na, K and Ca were determined by RIA, Flame photometer and Flame atomic absorption respectively. All envenomed children showed significant surge of adrenaline, noradrenaline, ACE, Ang II, aldosterone, NO and Na, that concomitantly faced by significant reduction in kallikrein, K and Ca on admission. Twenty four hours later, all envenomed children continued to show significant elevation of ACE, Ang II and NO. The severely envenomed children showed considerable reduction in circulating levels of adrenaline, noradrenaline, ACE and Ang II, while dramatic increase in kallikrein activity was reported in comparison to mildly envenomed children after 24 h of medical care. Also, NO exhibited considerable accumulation in non survivors, on admission, that was persistent for the subsequent 24 h and was accompanied by high kallikrein, low catecholamines and Ang II levels compared to survivors. Finally, the hypertensive cases showed substantial higher levels of catecholamine, ACE and Ang II, 24 h after admission. These findings indicated that, disturbances of the studied vasoactive mediators were common in scorpion envenomed children and may account for several inflammatory manifestations and clinical outcome. ACE inhibitors could be considered as possible therapeutic agent in victims with prominent increase in ACE and Ang II while kallikrein inhibitor and antioxidants may be effective in the treatment of late hypotensive ones.
蝎子蜇伤会引发自主神经风暴，导致血管活性介质水平发生变化，进而引起心肌损伤、心血管紊乱、外周循环衰竭、肺水肿、多系统器官衰竭甚至死亡。本研究旨在测定蝎子蜇伤儿童体内肾上腺素、去甲肾上腺素、血管紧张素转换酶（ACE）、血管紧张素II（Ang II）、激肽释放酶、一氧化氮（NO）、醛固酮以及电解质钠、钾和钙的循环水平，并评估这些血管活性介质之间的潜在关系、蝎子蜇伤的严重程度以及蜇伤儿童的临床结局。40名蜇伤儿童（22例轻度和18例重度）以及10名健康对照儿童参与了本研究。入院时及24小时后，采用酶联免疫吸附测定法（ELISA）和分光光度法测定肾上腺素、去甲肾上腺素、Ang II、ACE、激肽释放酶和NO的循环水平。入院时，分别采用放射免疫分析法（RIA）、火焰光度计和火焰原子吸收法测定血清醛固酮以及电解质钠、钾和钙。所有蜇伤儿童入院时均出现肾上腺素、去甲肾上腺素、ACE、Ang II、醛固酮、NO和钠的显著升高，同时激肽释放酶、钾和钙显著降低。24小时后，所有蜇伤儿童的ACE、Ang II和NO仍持续显著升高。与轻度蜇伤儿童相比，重度蜇伤儿童在接受治疗24小时后，肾上腺素、去甲肾上腺素、ACE和Ang II的循环水平显著降低，而激肽释放酶活性显著增加。此外，入院时，非幸存者体内的NO大量蓄积，在随后的24小时内持续存在，与幸存者相比，其激肽释放酶水平高、儿茶酚胺和Ang II水平低。最后，高血压病例在入院24小时后，儿茶酚胺、ACE和Ang II水平显著升高。这些研究结果表明，所研究的血管活性介质紊乱在蝎子蜇伤儿童中很常见，可能是多种炎症表现和临床结局的原因。对于ACE和Ang II显著升高的受害者，可考虑将ACE抑制剂作为可能的治疗药物，而激肽释放酶抑制剂和抗氧化剂可能对晚期低血压患者的治疗有效。
