探讨异比特蛇毒液对人血液凝血、超微结构及粘弹性的体外影响

IF 3.4 3区医学 Q2 HEMATOLOGY

Research and Practice in Thrombosis and Haemostasis Pub Date : 2025-08-01 DOI:10.1016/j.rpth.2025.103173

Courtney Hill , Christie Megaw , Johan Potgieter , Morné A. Strydom , Janette Bester

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引用次数: 0

摘要

背景：蛇咬伤是影响热带和亚热带地区的一个重大但经常被忽视的公共卫生挑战。变异比特炎毒液毒素具有细胞毒性作用并导致凝血功能障碍。然而，关于与B型兽类中毒相关的凝血病或将传统诊断测试与即时诊断（POC）方法进行比较的文献有限。目的研究异角蛇毒对人血液凝固的影响，并比较20分钟全血凝血试验（20-WBCT）与其他POC凝血试验。方法将人血液暴露于2 ng/μL的动物毒液中。使用20-WBCT研究血栓形成。测量凝血酶原时间，活化部分凝血活酶时间，凝血酶时间和纤维蛋白原水平，以获得每个参与者的血液学凝血概况。用血栓弹性成像（TEG）定量测定全血凝块动力学的粘弹性特性。用扫描电镜分析红细胞形态和血块结构。结果大鼠蛇毒对小鼠红细胞形态和血块结构有显著影响。20-WBCT和临床凝血试验显示，暴露于毒液的样本结果有显著差异；然而，它们仍然在正常范围内。TEG显示低凝血和凝块稳定性下降。毒液暴露样本的形态学研究显示棘刺细胞有不同程度的形态异常和膜泡。此外，暴露于毒液的血凝块具有稀疏、无组织的纤维蛋白网络和有限的交联。结论变异比特炎毒液中含有多种血液毒素，可破坏正常凝块形成，影响TEG参数。这些见解提供了临床和实验室分析之间的必要联系。该研究证明了TEG作为一种POC测试在蛇咬伤管理中的价值，因为它可以更好地指示与中毒相关的凝血功能。

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Exploring the ex vivo effects of Bitis arietans snake venom on the coagulation, ultrastructure, and viscoelastic properties of human blood

Background

Snakebite envenoming represents a significant and frequently overlooked public health challenge affecting tropical and subtropical regions. Bitis arietans venom toxins have cytotoxic effects and result in coagulopathy. However, there is limited literature on coagulopathies associated with B arietans envenomation or comparing traditional diagnostic tests with point-of-care (POC) methods.

Objectives

This study investigated the effects of B arietans venom on the coagulation of human blood, with a focus on comparing the 20-minute whole blood clotting test (20-WBCT) to other POC coagulation tests.

Methods

This study exposed human blood to 2 ng/μL B arietans venom ex vivo. Clot formation was studied using the 20-WBCT. Prothrombin time, activated partial thromboplastin time, thrombin time, and fibrinogen levels were measured to obtain hematological clotting profiles of each participant. Viscoelastic properties of whole blood clot kinetics were quantified using thromboelastography (TEG). Red blood cell morphology and clot architecture were analyzed using scanning electron microscopy.

Results

Bitis arietans venom had significant effects on red blood cell morphology and clot structure. Both the 20-WBCT and clinical coagulation assays revealed notable differences in the results of venom-exposed samples; however, they were still in the normal range. TEG indicated hypocoagulation and decreased clot stability. Morphological studies of venom-exposed samples revealed echinocytes with varying degrees of morphological abnormalities and membrane blebbing. In addition, venom-exposed blood clots had sparse, disorganized fibrin networks and limited crosslinking.

Conclusion

Bitis arietans venom contains various hemotoxins that disrupt normal clot formation and affect TEG parameters. These insights provide a necessary link between clinical and laboratory analysis of B arietans venom. The study demonstrates the value of TEG as a POC test in snakebite management as it could provide a better indication of coagulopathy associated with envenomation.

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