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被毒牙蝰蛇(Crotalus horridus horridus)咬伤后出现的类弥散性血管内凝血综合征。

DiC-like syndrome after envenomation by the snake, Crotalus horridus horridus.

作者信息

Hasiba U, Rosenbach L M, Rockwell D, Lewis J H

出版信息

N Engl J Med. 1975 Mar 6;292(10):505-7. doi: 10.1056/NEJM197503062921004.

Abstract

After envenomation by the timber rattlesnake (Crotalus horridus horridus) a young man showed massive swelling and ecchymoses of the involved extremity, generalized petechiae and a large hematoma of the left upper eyelid. Two weeks later he was completely well. The first blood sample was incoagulable and showed high titers of fibrin split products by the MISFI and staphylococcal clumping tests. Immounoelectrophoresis showed both D and E fragments, but only D was present at 18 hours. The profound thrombocytopenia and hypofibrinogenemia gradually improved, and split products disappeared. In vitro the venom had thrombin-like activity, clotting fibrinogen or plasma and aggregating platelets. These activities could be inhibited by antivenom but not by heparin. There was no evidence that thrombin formation was actually involved: hence, the syndrome is called DIC-like.

摘要

被木纹响尾蛇(Crotalus horridus horridus)咬伤后,一名年轻男子受伤肢体出现大面积肿胀和瘀斑,全身出现瘀点,左上眼睑有一大块血肿。两周后他完全康复。第一份血样无法凝固,通过MISFI和葡萄球菌凝集试验显示纤维蛋白裂解产物的滴度很高。免疫电泳显示有D和E片段,但在18小时时仅存在D片段。严重的血小板减少症和低纤维蛋白原血症逐渐改善,裂解产物消失。在体外,毒液具有类凝血酶活性,可使纤维蛋白原或血浆凝固并使血小板聚集。这些活性可被抗蛇毒血清抑制,但不能被肝素抑制。没有证据表明实际涉及凝血酶的形成:因此,该综合征被称为类弥散性血管内凝血。

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