Infectious & Tropical Diseases Unit, Department of Medicine, Bayero University Kano, Aminu Kano Teaching Hospital, Kano, Kano State, Nigeria.
Toxicon. 2013 Jul;69:82-9. doi: 10.1016/j.toxicon.2013.01.002. Epub 2013 Jan 20.
In West Africa, response to specific, geographically appropriate, antivenom is often dramatic following carpet viper (Echis ocellatus) envenoming with rapid restoration of blood coagulability and resolution of spontaneous haemorrhage. Envenoming from Australasian snakes causing similar coagulopathies may respond less dramatically and the effectiveness of antivenom is being questioned. Here we have reviewed and re-analysed all published preclinical and clinical studies on envenoming and antivenom therapy conducted in West Africa to determine the effectiveness of antivenom. 22 studies provided relevant information: 12 observational studies, 4 RCTs and 6 preclinical studies. Four comparative studies confirmed statistically significant protection against mortality ranging from 57 to 87% using specific antivenoms compared to non-specific or no antivenoms. Meta-analysis estimated combined Odds Ratio (95% CI) of 0.25 (0.14-0.45) of dying among those treated with specific antivenom or 75% (95% CI: 55-86%) protection against death. Mortality more than doubled during times when stocks of reliable antivenoms ran out, with Relative Risk (95% CI)] of 2.33 (1.26-4.06). Serum kinetics of venom antigen/antivenom levels also confirmed that decline of venom antigen levels coincided with resolution of coagulopathy while decline of antivenom levels was associated with venom antigen reappearance and recurrence of coagulopathy. Preclinical and antivenomics analysis confirmed efficacy of regionally appropriate antivenoms against E. ocellatus and related species' venoms in Sub-Saharan Africa but not against Asian Echis carinatus venom. Antivenoms raised against E. carinatus were ineffective in human studies. In West Africa, specific antivenom is effective in managing carpet viper envenoming. A centralized hub-and-spoke strategy is suggested for broadening antivenom access to endemic rural areas together with instituting quality assurance, standardization and manpower training. Benefits, risks, cost-effectiveness and feasibility of the approach should be formally assessed.
在西非，针对特定的、地理位置适宜的抗蛇毒血清进行治疗，往往能迅速恢复凝血功能，并解决自发性出血，对地毯毒蛇（Echis ocellatus）的毒液产生显著的反应。而在澳大利亚蛇类引起的类似凝血疾病中，抗蛇毒血清的效果可能不太显著，其有效性也受到了质疑。在这里，我们回顾并重新分析了在西非发表的所有关于蛇伤和抗蛇毒血清治疗的临床前和临床研究，以确定抗蛇毒血清的疗效。22 项研究提供了相关信息：12 项观察性研究、4 项 RCT 和 6 项临床前研究。四项比较研究证实，与非特异性或无抗蛇毒血清相比，使用特定抗蛇毒血清可提供统计学上显著的保护作用，死亡率从 57%至 87%不等。荟萃分析估计，使用特定抗蛇毒血清治疗的患者死亡的合并优势比（95%置信区间）为 0.25（0.14-0.45），即 75%（95%置信区间：55-86%）的死亡率得到了保护。当可靠的抗蛇毒血清库存耗尽时，死亡率增加了一倍以上，相对风险（95%置信区间）为 2.33（1.26-4.06）。蛇毒抗原/抗蛇毒血清水平的血清动力学也证实，蛇毒抗原水平的下降与凝血功能障碍的解决相吻合，而抗蛇毒血清水平的下降与蛇毒抗原的再次出现和凝血功能障碍的复发有关。临床前和抗蛇毒血清分析证实，针对撒哈拉以南非洲地区的 E. ocellatus 和相关物种毒液的区域性适当抗蛇毒血清是有效的，但对亚洲的 Echis carinatus 毒液无效。针对 E. carinatus 产生的抗蛇毒血清在人体研究中无效。在西非，特定的抗蛇毒血清在治疗地毯毒蛇咬伤方面是有效的。建议建立一个集中的中心辐射状策略，扩大抗蛇毒血清在流行地区农村地区的获取渠道，同时建立质量保证、标准化和人力培训。应正式评估该方法的效益、风险、成本效益和可行性。
