"Bad things come in small packages": predicting venom-induced coagulopathy in Bothrops atrox bites using snake ontogenetic parameters
"Bad things come in small packages": predicting venom-induced coagulopathy in Bothrops atrox bites using snake ontogenetic parameters
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DOI：
10.1080/15563650.2019.1648817
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发表时间：
2019-08-02
影响因子：
3.3
通讯作者：
Monteiro, Wuelton Marcelo
中科院分区：
文献类型：
--
作者：
Contreras Bernal, Jorge Carlos;Bisneto, Pedro Ferreira;Monteiro, Wuelton Marcelo
导言：蛇毒成分具有明显的种间和种内变异。在亚马逊地区毒蛇咬伤的主要原因--毒蛇属物种--的案例中，地理和个体遗传变量会影响毒液的组成，具有生态和医学意义。以前的研究表明，来自新生和幼蛇标本的毒液在体外具有较高的凝血活性。这项研究的目的是评估临床结果，如毒液诱导的凝血障碍和局部并发症与阿曲霉杆菌个体发育变量的关系。方法：探讨亚马逊地区阿曲霉毒素中毒患者的临床参数与被咬蛇标本的形态计量学参数之间的关系。结果：有248份标本被确认为毒液，以雌性蛇为主(70.5%)，幼年蛇占62.7%。被新生儿咬伤的患者比被成年蛇咬伤的患者[OR=2.70(95%CI 1.15-6.37)；p=.021]和被尾巴尖端为白色的蛇咬伤[OR=1.98(95%CI 1.15-3.41)；p=.013]更容易发生凝血障碍。从患者入院到未凝血恢复的时间不受蛇的性别(p=.214)或年龄(p=.254)的影响。与被成年蛇咬伤的患者相比，被新生儿(p=.024)或幼年蛇(p<；.0001)咬伤的患者出现中度至重度浮肿的频率较低。与实验观察一致的是，被新生儿和白尾蛇咬伤的患者比被成年蛇咬伤的患者更有可能发生凝血障碍。相比之下，成年蛇的毒液与严重局部水肿的发生率较高相关。结论：尽管有这些变化，但在使用Bothrops抗蛇毒血清后，这些患者恢复凝血所需的时间没有差异。
Introduction: Snake venom composition shows significant inter- and intra-species variation. In the case of the viperid species Bothrops atrox, responsible for the majority of snakebites in the Amazon region, geographical and ontogenetic variables affect venom composition, with ecological and medical implications. Previous studies had shown that venom from neonate and juvenile Bothrops specimens have a higher in vitro coagulant activity. The aim of this investigation was to assess the association of clinical outcomes, such as venom-induced coagulopathy and local complications, with B. atrox ontogenetic variables. Methods: This study explored the relationship between some clinical parameters in patients suffering envenomations by B. atrox in the Amazon and several morphometric parameters of the snake specimens causing the bites. Results: There were 248 specimens confirmed as agents of envenomation, mostly female snakes (70.5%) and classified as juveniles (62.7%). Patients bitten by neonates compared to adult snakes [OR = 2.70 (95%CI 1.15-6.37); p = .021] and by snakes with white tail tip [OR = 1.98 (95%CI 1.15-3.41); p = .013] were more likely to develop coagulopathy. Time from patient admission to the unclottable blood reversion was not affected by the snake gender (p = .214) or age (p = .254). Patients bitten by neonate (p = .024) or juvenile snakes (p < .0001) presented a lower frequency of moderate to severe edema, as compared to those bitten by adult snakes. In agreement with experimental observations, patients bitten by neonates and by snakes with a white tail tip were more likely to develop coagulopathy than those bitten by adult snakes. In contrast, envenomations by adult snakes were associated with a higher incidence of severe local edema. Conclusion: Despite these variations, no difference was observed in the time needed to recover blood clotting in these patients after Bothrops antivenom administration.