蝮蛇咬伤后心肌损伤及其与毒液诱导凝血病的关系。

IF 2.6 4区医学 Q2 PHARMACOLOGY & PHARMACY

Toxicon Pub Date : 2025-03-07 DOI:10.1016/j.toxicon.2025.108312

Marco Aurélio Sartim , Maria Raimunda da Costa , Karolaine Oliveira Bentes , Victor Irungu Mwangi , Thiago Serrão Pinto , Samella Oliveira , Jady Shayene Mota Cordeiro , José Wilson do Nascimento Corrêa , João Marcos Bemfica Barbosa Ferreira , Gisely Cardoso de Melo , Jacqueline Sachett , Wuelton Marcelo Monteiro

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引用次数: 0

摘要

背景：在巴西，亚马逊地区是蛇咬中毒（SBE）发生率最高的地区，主要由Bothrops atrox引起。在中毒的影响中，心脏改变不是常见的结果，但与严重病例密切相关。目的：本研究探讨了Bothrops SBEs后心脏损伤标志物（脂肪酸结合蛋白3 - H-FABP3、n端B型利钠肽- NTproBNP、肌酸激酶- mb - CPK-MB和肌钙蛋白I）的血清特征及其与毒蛇诱导凝血病的关系。方法：对巴西亚马逊地区玛瑙斯某三级医院收治的80例B. atrox SBE患者在入院（抗蛇毒血清T0前）和抗蛇毒血清T48后48小时采集的血液及20例健康献血者的血浆标志物进行评价。结果：与性别和年龄匹配的健康对照组相比，标志物升高，高于参考范围，包括至少98.7%的患者中有FABP3, 12.5%的患者中有肌钙蛋白I， 8.8%的患者中有CK-MB。关于凝血标志物的相关性，α 2-抗纤溶蛋白浓度与FABP3水平呈负相关（T0），而FDP、组织因子和血浆因子VII水平与肌钙蛋白I浓度呈正相关。此外，肌钙蛋白I水平升高的患者组在T0时FDP浓度、因子VII水平和全身性出血风险显著升高，而在T48时d -二聚体浓度较高。结论：我们的研究结果表明，Bothrops SBE对心肌损伤负责，尽管与严重的结果无关，但它与蛇毒诱导的凝血功能障碍直接相关，这表明肌钙蛋白- 1和FABP3可能是筛选患者更详细的心脏改变的标志物。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

Myocardial injury and its association with venom-induced coagulopathy following Bothrops atrox snakebite envenomation

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Myocardial injury and its association with venom-induced coagulopathy following Bothrops atrox snakebite envenomation

Backgound

In Brazil, the highest incidences of snakebite envenomation (SBE) occur in the Amazon region, caused mostly by Bothrops atrox. Among the effects of envenomation, cardiac alterations are not a frequent outcome but are highly linked to severe cases.

Objective

The present study investigated the serum profile of cardiac injury markers (fatty acid binding protein 3 - H-FABP3, N-terminal type B natriuretic peptide - NTproBNP, creatine kinase-MB - CPK-MB, and troponin I) following Bothrops SBEs and their association with venom-induced coagulopathy.

Methods

Plasma markers were evaluated from blood collected at admission (before antivenom - T0) and 48h after antivenom (T48) from 80 B. atrox SBE patients treated at a tertiary hospital in Manaus, Brazilian Amazon, and 20 healthy donors.

Results

Markers were found increased, above reference range or compared to sex- and age-matched healthy controls, including FABP3 in at least 98.7% of patients, Troponin I 12.5%, and CK-MB in 8.8%. Regarding correlations to coagulation markers, alpha 2-antiplasmin concentrations were negatively correlated with FABP3 levels (T0), whereas FDP, tissue factor, and plasma factor VII levels were positively correlated with troponin I concentrations. Moreover, the group of patients with increased troponin I levels presented significantly higher FDP concentrations, factor VII levels, and risk for systemic bleeding at T0, whereas higher D-dimer concentrations at T48.

Conclusions

Our findings show that Bothrops SBE is responsible for myocardial injury, although not associated with severe outcomes, and its directly associated to venom-induced coagulopathy, indicating troponin-I and FABP3 as possible markers to screen patients for more detailed cardiac alterations.

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来源期刊

Toxicon 医学-毒理学

CiteScore

4.80

自引率

10.70%

发文量

358

审稿时长

68 days

期刊介绍： Toxicon has an open access mirror Toxicon: X, sharing the same aims and scope, editorial team, submission system and rigorous peer review. An introductory offer Toxicon: X - full waiver of the Open Access fee. Toxicon''s "aims and scope" are to publish: -articles containing the results of original research on problems related to toxins derived from animals, plants and microorganisms -papers on novel findings related to the chemical, pharmacological, toxicological, and immunological properties of natural toxins -molecular biological studies of toxins and other genes from poisonous and venomous organisms that advance understanding of the role or function of toxins -clinical observations on poisoning and envenoming where a new therapeutic principle has been proposed or a decidedly superior clinical result has been obtained. -material on the use of toxins as tools in studying biological processes and material on subjects related to venom and antivenom problems. -articles on the translational application of toxins, for example as drugs and insecticides -epidemiological studies on envenoming or poisoning, so long as they highlight a previously unrecognised medical problem or provide insight into the prevention or medical treatment of envenoming or poisoning. Retrospective surveys of hospital records, especially those lacking species identification, will not be considered for publication. Properly designed prospective community-based surveys are strongly encouraged. -articles describing well-known activities of venoms, such as antibacterial, anticancer, and analgesic activities of arachnid venoms, without any attempt to define the mechanism of action or purify the active component, will not be considered for publication in Toxicon. -review articles on problems related to toxinology. To encourage the exchange of ideas, sections of the journal may be devoted to Short Communications, Letters to the Editor and activities of the affiliated societies.