Gonçalves Luís Roberto C, Sousa-e-Silva M Cristina C, Tomy Sandra C, Sano-Martins Ida S
Laboratório de Fisiopatologia, Instituto Butantan, Av. Vital Brazil, 1500, 05503-900, São Paulo, SP, Brazil.
Toxicon. 2007 Sep 1;50(3):349-56. doi: 10.1016/j.toxicon.2007.04.004. Epub 2007 Apr 21.
Large number of accidents caused by contact with Lonomia obliqua caterpillars, with hemorrhagic complications, have occurred in southern Brazil. Based on Venezuelan expertise to treat Lonomia achelous envenomation, the use of the antifibrinolytic drug epsilon-aminocaproic acid (EACA) has been indicated to treat L. obliqua envenomation, although no evidence has been presented to justify its use. Specific antivenom (antilonomic serum (ALS)) that neutralizes toxins that cause envenomation was developed. To compare the effectiveness of such treatments, rats were injected i.d. with the bristle extract of L. obliqua caterpillars and treated 15 min, 1 and 6 h after with saline, ALS, EACA, or with both ALS and EACA. ALS elicited fibrinogen recovery and normalization of thrombin time (TT), prothrombin time (PT) and activated partial thromboplastin time (APTT), independent of when it was administered; however, hematocrit was decreased in the group treated later. Saline or EACA-treated groups presented neither fibrinogen recovery nor normalization of hemostatic parameters. A high death rate was observed in the group treated with EACA 15 min after the envenomation. Prolongation of TT and APTT observed in the group treated with EACA and ALS indicated that this association gave no benefit in relation to the group treated solely with ALS. The results presented herein suggest that ALS is the only effective treatment for envenomation caused by contact with Lonomia obliqua caterpillars and indicate that EACA should not be administered in the initial phase of envenomation.
巴西南部发生了大量因接触斜带毒蛾毛虫而导致的事故,并伴有出血并发症。基于委内瑞拉治疗阿奇毒蛾中毒的专业经验,已建议使用抗纤维蛋白溶解药物ε-氨基己酸(EACA)来治疗斜带毒蛾中毒,尽管尚无证据证明其使用的合理性。已研发出能中和导致中毒的毒素的特异性抗蛇毒血清(抗斜带毒蛾血清(ALS))。为比较这些治疗方法的有效性,给大鼠皮下注射斜带毒蛾毛虫的刚毛提取物,并在15分钟、1小时和6小时后分别用生理盐水、ALS、EACA或同时使用ALS和EACA进行治疗。ALS能使纤维蛋白原恢复正常,并使凝血酶时间(TT)、凝血酶原时间(PT)和活化部分凝血活酶时间(APTT)恢复正常,且与给药时间无关;然而,较晚接受治疗的组血细胞比容降低。生理盐水或EACA治疗组既未出现纤维蛋白原恢复,也未实现止血参数正常化。在中毒后15分钟接受EACA治疗的组中观察到高死亡率。在EACA和ALS联合治疗组中观察到TT和APTT延长,这表明该联合治疗与单独使用ALS治疗的组相比并无益处。本文给出的结果表明,ALS是治疗因接触斜带毒蛾毛虫而导致中毒的唯一有效疗法,并表明在中毒初始阶段不应使用EACA。