Department of Infectious Disease and Clinical Microbiology, Faculty of Medicine, Cumhuriyet University, Sivas, Turkey.
Department of Biochemistry, Faculty of Medicine, Cumhuriyet University, Sivas, Turkey.
Ticks Tick Borne Dis. 2019 Aug;10(5):997-1002. doi: 10.1016/j.ttbdis.2019.05.008. Epub 2019 May 22.
Crimean-Congo Hemorrhagic Fever (CCHF) is an acute viral hemorrhagic disease. In this study, an evaluation was made of the potential use of iron metabolism and liver function biomarkers to estimate the bleeding status in CCHF patients. This prospective study was conducted in Cumhuriyet University, Turkey. Only patients with confirmed CCHF were enrolled in the study. The study subjects comprised 40 CCHF patients and 37 healthy control subjects. Serum iron, unsaturated iron binding capacity (UIBC), alanine aminotransferase (ALT), and aspartate aminotransferase (AST) levels were determined using the colorimetric method. Serum ferritin levels were measured using the electrochemiluminescent method. The serum ferritin (p = 0.037), AST (p = 0.0002), ALT (p = 0.002), LDH (p = 0.0005) and aPTT (p = 0.001) values were higher in patients with bleeding than in patients without bleeding. Receiving operating characteristic analyses were applied for the area under the curve (AUC) values for ferritin, aPTT, and AST to discriminate the bleeding status in patients, an these were determined as 0.717, 0.819, and 0.882, respectively. A cut-off value of 149 U/L for AST was obtained to discriminate the bleeding condition in CCHF patients. Higher ferritin (p < 0.0001) levels were determined in patients compared to the control group. The iron (p = 0.180) and UIBC (p = 0.0017) values were lower in patients than in the control group. Cytokine storm due to an increase in ferritin levels may contribute to the increased inflammation and coagulation abnormalities in CCHF patients. It was concluded that routine screening of the AST level would be helpful to estimate the bleeding status in addition to screening liver damage in CCHF patients.
克里米亚-刚果出血热（CCHF）是一种急性病毒性出血性疾病。本研究评估了铁代谢和肝功能生物标志物在估计 CCHF 患者出血状态中的潜在用途。这项前瞻性研究在土耳其的共和大学进行。只有确诊的 CCHF 患者才被纳入本研究。研究对象包括 40 名 CCHF 患者和 37 名健康对照者。使用比色法测定血清铁、未饱和铁结合力（UIBC）、丙氨酸氨基转移酶（ALT）和天冬氨酸氨基转移酶（AST）水平。使用电化学发光法测量血清铁蛋白水平。与无出血患者相比，有出血的患者的血清铁蛋白（p=0.037）、AST（p=0.0002）、ALT（p=0.002）、LDH（p=0.0005）和 aPTT（p=0.001）值更高。为了区分患者的出血状态，对铁蛋白、aPTT 和 AST 的曲线下面积（AUC）值进行了接收者操作特征分析，结果分别为 0.717、0.819 和 0.882。AST 的截断值为 149 U/L，用于区分 CCHF 患者的出血情况。与对照组相比，患者的铁蛋白水平更高（p<0.0001）。患者的铁（p=0.180）和 UIBC（p=0.0017）值低于对照组。铁蛋白水平升高引起的细胞因子风暴可能导致 CCHF 患者炎症和凝血异常增加。研究结论认为，除了筛查 CCHF 患者的肝损伤外，常规筛查 AST 水平还有助于估计出血状态。
