Department of Clinical Toxicology and Pharmacology, Calvary Mater Newcastle, Newcastle, New South Wales, Australia.
Toxicology. 2010 Feb 9;268(3):148-54. doi: 10.1016/j.tox.2009.09.013. Epub 2009 Sep 25.
Despite widespread use of antivenoms, many questions remain about their effectiveness in the clinical setting. The almost universal acceptance of their value is based mainly on in vitro studies, animal studies and human observational studies. Numerous examples exist where they demonstrate clear benefit, such as consumption coagulopathy in viper envenoming, prevention of neurotoxicity in Australasian elapid bites, systemic effects in scorpion and funnel-web spider envenoming. There are also concerns about the quality and efficacy of some antivenoms. However, it is important not to confuse the efficacy of antivenom, defined as its ability to bind and neutralise venom-mediated effects under ideal conditions, and the effectiveness of antivenom, defined as its ability to reverse or prevent envenoming in human cases. There are numerous potential reasons for antivenom failure in human envenoming, of which antivenom inefficacy is only one. Other important reasons include venom-mediated effects being irreversible, antivenom being unable to reach the site of toxin-mediated injury, or the rapidity of onset of venom-mediated effects. A number of recent studies in Australia bring into question the effectiveness of some antivenoms, including snake antivenom for coagulopathy, redback spider and box jellyfish antivenoms. Despite brown snake antivenom being able to neutralise venom induced clotting in vitro, use of the antivenom in human envenoming does not appear to change the time course of coagulopathy. However, it is important that apparent antivenom ineffectiveness in specific cases is correctly interpreted and does not lead to a universal belief that antivenom is ineffective. It should rather encourage further studies to investigate the underlying pathophysiology of envenoming, the pharmacokinetics of venoms and antivenoms, and ultimately the effectiveness of antivenom based on snake type, clinical effects and timing of administration.
尽管抗蛇毒血清被广泛应用，但在临床环境中其有效性仍存在诸多问题。人们普遍接受其价值主要基于体外研究、动物研究和人类观察性研究。大量实例表明，抗蛇毒血清具有明确的益处，例如蝮蛇咬伤引起的凝血功能障碍、澳大利亚毒蛇咬伤中预防神经毒性、蝎子和漏斗网蜘蛛咬伤中的全身性效应。但也存在一些关于抗蛇毒血清质量和疗效的担忧。然而，重要的是不要混淆抗蛇毒血清的疗效和有效性。抗蛇毒血清的疗效是指其在理想条件下结合和中和毒液介导的效应的能力，而抗蛇毒血清的有效性是指其在人类病例中逆转或预防中毒的能力。在人类中毒中，抗蛇毒血清失败的原因有很多，抗蛇毒血清无效只是其中之一。其他重要原因包括毒液介导的效应是不可逆转的、抗蛇毒血清无法到达毒素介导损伤的部位，或者毒液介导的效应发生得非常迅速。澳大利亚最近的一些研究质疑了一些抗蛇毒血清的有效性，包括用于凝血功能障碍的蛇抗毒血清、红背蜘蛛和箱形水母抗毒血清。尽管棕蛇抗毒血清能够在体外中和毒液诱导的凝血，但在人类中毒中使用该抗毒血清似乎并不能改变凝血功能障碍的时间进程。然而，重要的是，在特定情况下，抗蛇毒血清的明显无效性应被正确解释，而不应导致普遍认为抗蛇毒血清无效。相反，这应该鼓励进一步的研究，以调查中毒的潜在病理生理学、毒液和抗蛇毒血清的药代动力学，以及最终基于蛇的类型、临床效果和给药时间来评估抗蛇毒血清的有效性。
