The spiny dogfish (Squalus cubensis/megalops group): the envenoming of a fisherman, with taxonomic and toxinological comments on the Squalus genus.

The authors report a spiny dogfish (Squalus cubensis/megalops group) sting of a professional fisherman. He was injured on the left hand by the spine anterior to the fish's dorsal fin and manifested local edema, erythema, and excruciating pain for 6 h. Sharks of the genus Squalus megalops/cubensis and Squalus acanthias are found throughout the world; they have two spines in front of their dorsal fins and channels with a whitish mass containing large vacuolated cells which secrete venom. The Squalus genus has a complex taxonomy; the species involved in this injury belongs to the megalops/cubensis group. A detailed taxonomic and toxinological study on the Squalus genus is important and would complement other work on these fish, especially as stings in humans are very rare and not fully understood.     

大剂量糖皮质激素联合抗蛇毒血清治疗竹叶青蛇伤致DIC的疗效

目的观察大剂量糖皮质激素联合抗蛇毒血清在治疗竹叶青蛇伤致DIC中的疗效。方法57例竹叶青蛇伤致DIC患者按单盲随机法分为两组,对照组28例,治疗组29例。对照组予常规综合治疗+抗蝮蛇血清;治疗组在对照组基础上加用甲基强的松龙1000m g/d,观察两组疗效及凝血酶原时间(PT)、纤维蛋白原(Fg)和血小板(PLT)的恢复时间。结果治疗组总有效率96.6%,对照组总有效率75.0%,两者差异有显著性(P<0.05);治疗组PT、Fg、PLT与对照组比较,有显著性差异(P<0.05)。结论大剂量糖皮质激素联合抗蛇毒血清治疗竹叶青蛇伤致DIC可明显缩短凝血指标恢复时间及提高疗效。可以对竹叶青蛇毒起较好的中和作用,取得满意的临床治疗效果。     

Rapid and Efficient Enrichment of Snake Venoms from Human Plasma Using a Strong Cation Exchange Tip Column to Improve Snakebite Diagnosis

Snake envenomation is a serious public health issue in many tropical and subtropical countries. Accurate diagnosis and immediate antivenom treatment are critical for effective management. However, the venom concentration in the victims’ plasma is usually low, representing one of the bottlenecks in developing clinically applicable assays for venom detection and snakebite diagnosis. In this study, we attempted to develop a simple method for rapid enrichment of venom proteins from human plasma to facilitate detection. Our experiments showed that several major protein components of both Naja atra (N. atra) and Bungarus multicinctus (B. multicinctus) venoms have higher isoelectric point (pI) values relative to high-abundance human plasma proteins and could be separated via strong cation exchange–high-performance liquid chromatography (SCX-HPLC). Based on this principle, we developed an SCX tip column-based protocol for rapid enrichment of N. atra and B. multicinctus venom proteins from human plasma. Application of liquid chromatography-tandem mass spectrometry (LC-MS/MS) led to the identification of cytotoxin and beta-bungarotoxin as the major proteins enriched by the SCX tip column in each venom sample. The entire process of venom enrichment could be completed within 10–15 min. Combination of this method with our previously developed lateral flow strip assays (rapid test) significantly enhanced the sensitivity of the rapid test, mainly via depletion of the plasma protein background, as well as increase in venom protein concentration. Notably, the SCX tip column-based enrichment method has the potential to efficiently enrich other Elapidae snake venoms containing proteins with higher pI values, thereby facilitating venom detection with other assays. This simple and rapid sample preparation method should aid in improving the clinical utility of diagnostic assays for snakebite.     

循环毒毒蛇咬伤患者外周血Th1/Th2细胞因子的表达及意义

目的分析外周血Th1/Th2细胞因子在循环毒毒蛇咬患者中的表达,探讨其在病情评估中的意义。方法收集2016年3月至2017年10月循环毒毒蛇咬伤患者108例,根据国际蛇伤诊断标准分为轻度蛇咬伤组82例与重度蛇咬伤组26例,另外选择同期体检健康者30例为对照组。通过流式细胞术检测并比较分析各组患者T淋巴细胞亚群的分布情况及外周血Th1/Th2细胞因子的表达。结果与对照组比较,重度蛇咬伤组CD3^+、CD4^+T淋巴细胞水平偏低(P<0.01);细胞因子IL-4、IL-6、IL-10、TNF-α表达水平升高(P<0.05)。蛇咬伤组两两比较,重度蛇咬伤组CD3^+、CD4^+T淋巴细胞水平低于轻度蛇咬伤组(P<0.05),IL-4、IL-6、TNF-α表达水平均高于轻度蛇咬伤组(P<0.05)。结论循环毒毒蛇咬伤患者中存在有明显的T淋巴细胞数量的改变和Th1/Th2细胞因子表达紊乱,且与病情严重程度相关。     

重庆地区蛇咬伤后急救处理

目的：探讨重庆地区蛇咬伤的急救处理及分析治疗过程中凝血功能变化。方法回顾性分析我院2003年1月～2013年9月收治的1191例蛇咬伤患者（男性696例,女性495例;年龄16～81岁,平均45.2岁）临床表现、治疗情况、凝血功能变化及分泌物细菌培养等。结果重庆地区蛇咬伤以蝮蛇为主,轻型患者830例（69.69％）,就诊时临床表现以患肢肿胀常见,占92.35％。五步蛇及眼镜蛇较蝮蛇导致凝血系统异常具有显著性差异（ P＜0.05）。咬伤溃疡创面分泌物行细菌加药敏试验培养率49.5％,细菌培养阳性率21.3％。结论我院蛇咬伤以蝮蛇咬伤常见,五步蛇及眼镜蛇等咬伤较少,但对凝血功能影响显著,需及早综合处理蛇伤,合理运用抗菌药物,提高防治水平。     

血液净化联合季德胜蛇药片救治蛇咬伤致急性肾损伤临床观察刘皖娟 叶慧娟 叶文燕 丽水市中心医院急诊科 323000

目的 探讨血液净化联合季德胜蛇药片救治蛇咬伤致急性肾损伤的临床疗效。方法 选择2010年1月至2015年1月于我院接诊69例毒蛇咬伤后急性肾损伤患者,用随机数字表分组分为观察组和对照组,对照组33例主要运用常规的抗蛇毒血清进行治疗,观察组36例在对照组治疗基础上加用血液净化联合季德胜蛇药片,治疗后对比两组疗效及肾功能Cr,BUN,Cys-C,β2-MG,KIM-1,NAG指标情况。结果 治疗后对比两组有效率,观察组有效率94.44%,对照组有效率75.76%,观察组有效率高于对照组,统计对比两组数据,P<0.05;对比两组肾功能指标情况,观察组各项指标较对照组改善更为明显,统计对比差异性显著,P<0.05。结论 血液净化联合季德胜蛇药片在治疗蛇咬伤致急性肾损伤中疗效确切,,可以提高患者的治愈率,及时有效的改善肾功能,值得临床推广应用。     

Diagnosis of Snakebite and the Importance of Immunological Tests in Venom Research

In many cases of envenoming following snake bite, the snake responsible for the accident remains unidentified; this frequently results in difficulty deciding which antivenom to administer to the systemically-envenomed victim, especially when only monospecific antivenoms are available. Normally the specific diagnosis of snake bite can be conveniently made using clinical and laboratory methods. Where clinical diagnosis depends upon the recognition of specific signs of envenoming in the patient, laboratory diagnosis is based on the changes which occur in envenomed victims including the detection of abnormalities in blood parameters, presence/absence of myoglobinuria, changes in certain enzyme levels, presence/absence of neurotoxic signs and the detection in the blood of specific venom antigens using immunologically-based techniques, such as enzyme immunoassay. It is the latter which is the main subject of this review, together with the application of techniques currently used to objectively assess the effectiveness of new and existing antivenoms, to assess first aid measures, to investigate the possible use of such methods in epidemiological studies, and to detect individual venom components. With this in mind, we have discussed in some detail how such techniques were developed and how they have helped in the treatment of envenoming particularly and in venom research in general.     

血浆置换救治儿童急性毒蕈中毒

目的探讨毒蕈中毒患儿进行血浆置换的效果。方法4例患儿（男3例,女1例）,年龄分别为2、6、6、8岁,食用野生蘑菇0．5—1h后出现恶心、呕吐、腹痛、腹泻等急性胃肠道症状。经常规治疗症状无明显缓解,且出现肝及心肌损害。（发病后2-3d）给予血浆置换及对症、支持治疗。密切观察病情。结果入住儿童重症监护中心2周后患儿病情均好转出院。结论及时进行血浆置换能提高毒蕈中毒的救治率。     

被毒蛇咬伤患者血浆D-二聚体和常规凝血指标的变化及意义

目的探讨被不同毒性毒蛇咬伤后患者血浆D-二聚体(D-D)和常规凝血指标的变化及临床意义。方法58例被毒蛇咬伤患者(其中血循毒35例,非血循毒23例),在被毒蛇咬伤后就诊未治疗前,采集血标本检测D-D和血浆凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、血浆纤维蛋白原(FIB)含量及血小板计数(PLT)等,并与30例正常对照比较分析。结果血循毒组及非血循毒组D-D、PT、APTT明显高于对照组,其中血循毒组明显高于非血循毒组;PLT明显低于对照组,其中血循毒组明显低于非血循毒组;FIB血循毒组明显低于对照组,而非血循毒组明显高于对照组。血循毒组D-D含量与PT、APTT、FIB和PLT的异常变化具有一定的相关性;非血循毒患者血浆D-D含量变化与上述凝血指标的变化均无相关性。结论被血循毒毒蛇咬伤后易导致弥散性血管内凝血(DIC),检测患者D-D及常规凝血指标,可了解患者的凝血状况,防止DIC的进一步发生具有很好的临床意义。