ACUTE-RENAL-FAILURE FOLLOWING POISONOUS SNAKEBITE
ACUTE-RENAL-FAILURE FOLLOWING POISONOUS SNAKEBITE
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DOI：
10.1016/s0272-6386(84)80023-2
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发表时间：
1984-01-01
影响因子：
13.2
通讯作者：
SOMMERS, SC
中科院分区：
文献类型：
--
作者：
CHUGH, KS;PAL, Y;SOMMERS, SC
这项研究描述了人类蛇咬伤后的急性肾衰竭（ARF）以及蝰蛇毒液对亚人类灵长类动物肾脏结构和功能的影响。印度昌迪加尔研究生医学研究所医院收治的 157 名有蛇咬伤史的患者中，有 45 名出现了 ARF。对它们进行了临床、血液学研究，并在 35 例病例中进行了肾脏组织病理学研究。所有 45 人都接受了抗生素治疗，其中 8 人接受了抗蛇毒注射。双侧肾皮质坏死（BRCN）10例，死亡8例； 23 名患者出现不太严重的急性肾小管病变 (ATL)，其中 4 人死亡 (P< .001)。脓毒症在 BRCN 中比 ATL 中更常见 (P< .05)。这些组之间在出血发生率、弥散性血管内凝血（DIC）、溶血或低血压方面没有发现统计学差异。给予致死剂量蝰蛇毒液的猴子出现低血压休克、DIC和溶血，血清补体显着降低，并在24小时内死亡。然而，没有发现肾功能改变或病变。给予亚致死剂量的蝰蛇毒液的猴子在 48 小时后血清肌酐水平显着升高，并且大多数动物都观察到肾脏病变。总之，蛇咬伤患者出现 ARF 的原因似乎是多因素的。尽管低血压、溶血和DIC可能是重要的致病因素，但不能排除毒液对肾脏产生ARF的直接细胞毒性作用。
This study describes acute renal failure (ARF) following snakebite in humans and the effects of viperide venoms on the renal structure and function in subhuman primates. ARF developed in 45 of 157 patients with a history of snakebite admitted to the hospitals of the Postgraduate Medical Institute, Chandigarh, India. They were studied clinically, hematologically, and in 35 cases, for renal histopathology. All 45 were treated with antibiotics, and 8 received anti-snake venom. Ten cases had bilateral renal cortical necrosis (BRCN), eight of whom died; less severe acute tubular lesions (ATL) occurred in 23 patients, four of whom died (P< .001). Sepsis was significantly more common with BRCN than ATL (P< .05). No statistical difference was found between these groups in bleeding incidence, disseminated intravascular coagulation (DIC), hemolysis, or hypotension. Monkeys given lethal doses of viperide venom developed hypotensive shock, DIC, and hemolysis, with significantly reduced serum complement, and died within 24 hours. However, no renal functional changes or lesions were found. Monkeys given sublethal doses of viperide venom showed a significant increase in serum creatinine levels after 48 hours, and renal lesions were observed in a majority of animals. In conclusion, ARF in snakebite victims appears to be multifactorial in origin. Although hypotension, hemolysis, and DIC are likely to be important pathogenetic factors, a direct cytotoxic effect of the venom on the kidney in producing ARF cannot be excluded.