Warrell D A, Greenwood B M, Davidson N M, Ormerod L D, Prentice C R
Q J Med. 1976 Jan;45(177):1-22.
The Spitting Cobra, Naja nigricollis, is widely and densely distributed in Africa. Fourteen patients with proven N. nigricollis bites, who were seen in the savanna region of Nigeria, did not exhibit the neurological signs, such as cranial nerve lesions and respiratory paralysis, expected following Elapid poisoning. All had local swelling, in eight cases involving the entire limb, and ten developed local tissue necrosis. Spontaneous haemorrhage was detected in three cases and was the probable cause of death in one of them; the other death in this series was unexplained. Haematological abnormalities included prolonged clot lysis anf failure of clot retraction due to a platelet defect. There was no specific deficit in clotting factors and a delayed rise in fibrin degradation products was attributed to extensive tissue damage at the site of the bit. Most patients showed depletion of complement component C3 and glycine-rich beta-glycoprotein (GBG), suggesting activation of the alternative pathway of complement fixation. There was evidence of hepatocellular damage in two out of six patients investigated. There was no evidence that specific polyvalent antivenoms, used in doses of up to 80 ml, prevented any of the effects of N. nigricollis venom. Clinical laboratory diagnosis is discussed. In the past many bites were wrongly classified as viper bites on the basis of clinical findings. Immunodiagnosis is a promising method for assessing the true importance of N. nigricollis bite in West Africa.
唾蛇（黑颈眼镜蛇，Naja nigricollis）广泛且密集地分布于非洲。在尼日利亚热带草原地区诊治的14例经证实被黑颈眼镜蛇咬伤的患者，并未表现出预期的神经症状，如在眼镜蛇科中毒后出现的脑神经损害和呼吸麻痹。所有患者均有局部肿胀，8例累及整个肢体，10例出现局部组织坏死。3例检测到自发性出血，其中1例可能是死亡原因；该系列中的另1例死亡原因不明。血液学异常包括由于血小板缺陷导致的凝血块溶解时间延长和凝血块回缩失败。凝血因子无特异性缺乏，纤维蛋白降解产物延迟升高归因于咬伤部位的广泛组织损伤。大多数患者显示补体成分C3和富含甘氨酸的β-糖蛋白（GBG）减少，提示补体固定替代途径的激活。在6例接受调查的患者中，有2例有肝细胞损伤的证据。没有证据表明剂量高达80毫升的特异性多价抗蛇毒血清能预防黑颈眼镜蛇毒液的任何作用。本文讨论了临床实验室诊断。过去，许多咬伤根据临床症状被错误地归类为蝰蛇咬伤。免疫诊断是评估黑颈眼镜蛇咬伤在西非真正重要性的一种有前景的方法。
