Institut de Recherche pour le Développement, Cotonou, Bénin.
J Venom Anim Toxins Incl Trop Dis. 2013 Mar 28;19(1):6. doi: 10.1186/1678-9199-19-6.
In Guinea Elapids are responsible for 20% of envenomations. The associated case fatality rate (CFR) ranged 15-27%, irrespective of treatment.
We studied 77 neurotoxic envenomations divided in 3 groups: a set of patients that received only traditional or symptomatic treatments, and two other groups that received either 2 or 4 initial vials of Antivipmyn® Africa renewed as necessary. CFR was 27.3%, 15.4% and 17.6%, respectively. Although antivenom treatment was likely to reduce CFR, it didn't seem to have an obvious clinical benefit for the patients, suggesting a low treatment efficacy. Mean delay to treatment or clinical stages were not significantly different between the patients who recovered and the patients who died, or between groups. Interpretation of these results is complicated by the lack of systematic studies under comparable conditions. Of particular importance is the absence of assisted ventilation, available to patients in all the other clinical studies of neurotoxic envenomation.
The apparent lack of clinical benefit may have several causes. The hypothesis of a limited therapeutic window, i.e. an insufficient formation of antigen-antibody complexes once toxins are bound to their targets and/or distributed beyond the reach of antivenom, should be explored.
在几内亚，眼镜蛇科蛇类导致的咬伤占 20%。其相关的病死率（CFR）为 15-27%，无论是否接受治疗。
我们研究了 77 例神经毒性咬伤，分为 3 组：一组仅接受传统或对症治疗的患者，另外两组分别接受 2 或 4 初始瓶抗眼镜蛇蛇毒血清非洲（如有必要可更新）。CFR 分别为 27.3%、15.4%和 17.6%。尽管抗蛇毒血清治疗可能降低 CFR，但对患者似乎没有明显的临床获益，提示治疗效果较低。恢复和死亡患者之间，或各组之间，治疗或临床分期的平均延迟时间没有显著差异。由于缺乏可比条件下的系统研究，对这些结果的解释变得复杂。特别重要的是，所有其他神经毒性蛇伤的临床研究都为患者提供了辅助通气，而本研究中却没有。
明显缺乏临床获益可能有几个原因。应当探讨治疗窗有限的假说，即毒素与靶标结合后，或分布于抗蛇毒血清不可及的范围后，抗原-抗体复合物形成不足。
