Effectiveness of snake antivenom:: Species and regional venom variation and its clinical impact
Effectiveness of snake antivenom:: Species and regional venom variation and its clinical impact
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DOI：
10.1081/txr-120019018
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发表时间：
2003-01-01
期刊：
影响因子：
--
通讯作者：
Wüster, W
中科院分区：
文献类型：
--
作者：
Fry, BG;Winkel, KD;Wüster, W
蛇中普遍存在的毒液变异给抗蛇毒血清的生产带来了特殊的问题，并削弱了这类治疗剂的商业吸引力。特别是，已有充分证据表明，毒液组成的种间和种内变异都会影响抗蛇毒血清的中和能力。这可能是加剧了选择性使用的测试毒液毒性和抗蛇毒血清的效力，如。如致死剂量和ED 50，导致时间依赖性毒素（而非剂量依赖性毒素）的中和不足，特别是参与去纤维蛋白原、出血和坏死毒液活性的酶。其临床后果可能是降低对某些重要毒液活性的疗效，甚至在严重的毒液蛰入中完全治疗失败。所有这些因素，再加上世界范围内抗蛇毒血清生产商数量的持续减少，以及随之而来的抗蛇毒血清供应范围的缩小，都是重大的。21世纪世纪蛇咬伤治疗面临的挑战。
The ubiquity of venom variation in snakes poses special problems for the manufacture of antivenom and has undermined the commercial attractiveness of this class of therapeutic agent. In particular, it has been amply documented that both interspecific and intraspecific variation in venom composition can affect the neutralisation capacity of antivenoms. This may be exacerbated by the selective use of tests of venom toxicity and antivenom efficacy, such. as the lethal dose and ED50, resulting in inadequate neutralisation of time, rather than dose, dependent toxins, particularly enzymes involved in defibrinogenating, haemorrhagic and necrotising venom activities. The clinical consequences can be reduced efficacy against some important venom activities or even complete treatment failure in critical envenomations. All these factors, combined with the ongoing reduction in the number of antivenom manufacturers world-wide, and concomitant contraction in the range of available antivenoms, present significant. challenges for the treatment of snakebite in the 21st century.