Cupo P, Azevedo-Marques M M, Hering S E
Department of Pediatrics, Faculty of Medicine of Ribeirã Preto, University of São Paulo, Brazil.
Trans R Soc Trop Med Hyg. 1990 May-Jun;84(3):447-51. doi: 10.1016/0035-9203(90)90358-l.
The clinical signs and symptoms of Crotalus durissus terrificus envenoming are due to the neurotoxic, myotoxic systemic and thrombin-like coagulating effects of the venom. The rhabdomyolysis observed after envenoming caused by snakes, the venom of which has a systemic myotoxic activity, has been limited thus far to skeletal muscle, with no reports of myocardial damage. In the present paper we report serial measurements of serum creatine kinase (CK), lactic dehydrogenase (LD) and of CK-MB and LD1 isoenzymes in human victims of Crotalus bites. The results were similar to those reported for acute myocardial infarction even though the clinical evolution, electrocardiogram and echocardiogram findings did not show any involvement of cardiac muscle. The enzymatic profile detected, as well as the pattern of focal involvement observed in muscle biopsies obtained from these patients, suggest that there may be a type of skeletal muscle fibre that is preferentially damaged by C. durissus terrificus venom, i.e., type I and/or IIa fibres, the composition of which is richer in CK-MB and LD1, and is similar to that of cardiac fibres.
杜氏响尾蛇（Crotalus durissus terrificus）咬伤中毒的临床体征和症状是由毒液的神经毒性、肌毒性、全身毒性及类凝血酶凝血作用所致。迄今为止，由具有全身肌毒性活性毒液的蛇咬伤中毒后观察到的横纹肌溶解仅限于骨骼肌，尚无心肌损伤的报道。在本文中，我们报告了对杜氏响尾蛇咬伤人类受害者血清肌酸激酶（CK）、乳酸脱氢酶（LD）以及CK-MB和LD1同工酶的系列测量结果。尽管临床病程、心电图和超声心动图检查结果未显示任何心肌受累情况，但这些结果与急性心肌梗死的报告结果相似。检测到的酶谱以及从这些患者获得的肌肉活检中观察到的局灶性受累模式表明，可能存在一种优先被杜氏响尾蛇毒液损伤的骨骼肌纤维类型，即I型和/或IIa型纤维，其组成中CK-MB和LD1含量更高，且与心脏纤维相似。
