关于精制蝮蛇抗栓酶的问答

于1991年5月下旬在昆明召开的中国蛇毒酶临床应用研讨会后,陆续收到许多读者来信,询问精制蝮蛇抗栓酶有关问题。为了能较全面地回答读者来信,采访了有关专家并做了某些调查,对几个共同问题公开做答,不专门复信,见谅。一、精制蝮蛇抗栓酶的本质是什么?答:根据昆明会议信息。精制蝮蛇抗栓酶就是原来的“江浙蝮蛇毒抗栓酶-3号”,由中国医科大学老年病防治中心在沈阳第一制药厂生产的江浙蝮蛇抗栓酶(Svate)基础上,经过两次分离所得的产物。经过动物实验及临床验证认为:毒副反应明显低于原江浙蝮蛇抗栓酶。为了区别于原江浙蝮蛇抗栓酶,已被辽宁省卫生厅批准正式批量生产。商品名称为“精制蝮蛇抗栓酶”。为什么要取消“江浙”二字,其     

蝮蛇抗栓酶治疗庆大霉素中毒

应用蝮蛇抗栓酶治疗庆大霉素中毒6例,其中1例由于合并严重神经症状及应用蝮蛇抗栓酶时间延长,需8个月治愈,余5例因应用蝮蛇抗栓酶及时,两周即治愈.总之,应用蝮蛇抗栓酶治疗6例庆大霉素中毒患者均获得理想效果。     

清栓酶（蝮蛇抗栓酶）的药理研究与临床应用进展

清栓酶（蝮蛇抗栓酶）的药理研究与临床应用进展中国蛇协蛇毒研究所邓禄延,覃公平,胡征林自本世纪八十年代起,蛇毒抗凝制剂在我国研制及应用于临床以来,相继有尖吻蝮蛇毒制剂去纤酶,长白山陆生白眉蝮蛇毒制剂清栓酶（蝮蛇抗栓酶）及江浙蝮蛇毒制剂江浙蝮蛇毒抗栓酶（...     

紫外线照射和充氧自血回输加白眉蝮蛇抗栓酶治疗脑梗塞的临床实验研究

我们应用紫外线照射和充氧自血回输(简称自血回输)加白眉蝮蛇抗栓酶治疗急性脑梗塞,与单纯用自血回输及单纯用白眉蝮蛇抗栓酶治疗急性脑梗塞进行了临床实验研究.其结果自血回输加白眉蝮蛇抗栓酶疗法优于单纯自血回输疗法,更优于单纯白眉蝮蛇抗栓酶疗法.临床证明两者合用有协同作用,而且方法安全、简单、方便.     

蝮蛇抗栓酶的临床新用途

蝮蛇抗栓酶的临床新用途苏佳广西桂林南溪山医院（５４１００２）蝮蛇抗栓酶系从蝮蛇蛇毒中提取的一种酶制剂,具有溶栓、抗凝、扩血管和改善微循环作用,被广泛用于脑、心及周围血管性疾病。近年来,随着对蝮蛇抗栓酶药理学与临床研究的进一步深入,其用途也不断扩展,现...     

蝮蛇抗栓酶降粘解聚的效用：附82例分析

收治年龄与病情类似的高粘滞血症(HVS)82例,随机分为三组,分别静脉滴注蝮蛇抗栓酶;复方丹参注射液和口服肠溶阿斯匹林加维脑路通.结果蝮蛇抗栓酶组具有明显的降粘、去纤作用,对红细胞电泳速度及高密度脂蛋白的提升作用亦非常显著(P<0.01).三组比较,蝮蛇抗栓酶的降粘解聚作用明显优于其它两组的疗效.且副作用轻,未发现肝肾功能损伤和出血现象.     

蝮蛇抗栓酶与精制蝮蛇抗栓酶制剂的比较研究

本文作者对以东北长白山白眉蝮蛇毒为原料生产的两种酶制剂——蝮蛇抗栓酶与精制蝮蛇抗栓酶进行了比较研究。用 HPLC 柱层析粗毒得到15个蛋白峰,同时对两种酶制剂以 HPLC 层析用两根层析柱串联上样层析以提高其分辩率,得到两个图谱,蝮蛇抗栓酶有7个蛋白峰,而精制品有3～4个蛋白峰.同时以 SDS-PAGE 电泳图谱.蝮蛇抗栓酶呈现7～8条谱带,精制品有4～5条谱带,并与已知分子量的标准蛋白进行对比,结果表明两种酶制剂均非单一组分.蝮蛇抗栓酶谱带较多,精制品较纯.其分子量均在2～6万之间.蝮蛇抗栓酶几个组分有协同作用,每次剂量在0.25～0.50单位,即有明显疗效,而精制品临床用药剂量较大,每次0.75～1.0单位,多者达1.25单位(3～5支).     

蝮蛇抗栓酶治疗脑梗塞的护理（摘要）

蝮蛇抗栓酶治疗脑梗塞的护理（摘要）连云港市第一人民医院徐建梅我科目１９９０年以来,应用蝮蛇抗栓酶治疗脑梗塞疾病,副作用较少,疗效较高,我们的护理体会：用药中注意对药物疗效、不良反应的观察,指导肢体功能锻炼及语言训练,促进病人早日康复。蝮蛇抗栓酶治疗脑...     

蝮蛇抗栓酶冲击疗法治疗急性心肌梗塞17例

蝮蛇抗栓酶冲击疗法治疗急性心肌梗塞１７例张卫明,苏世祯永福县人民医院５４１８００本文１７例诊断急性心肌梗塞（ＡＭＩ）,为１９８９～１９９３年住院病人。采用蝮蛇抗栓酶［沈阳第一制药厂生产的江浙蝮蛇抗栓酶,每支含０．２５ｕ,Ｓｖａｔｅ,皮试阴性。］０．７...     

何谓“清栓酶”“AT—3”?

編辑同志: 近来我们发现蝮蛇抗栓酶的名目较多,有“清栓酶”,报纸上又见有“AT—3”,到底是不是同一样的产品? 田阳县医院邓有辉我国从蛇毒中提取有效成份制成抗血栓药物目前有三种,即用东北白眉蝮蛇毒制成“东北蝮蛇抗栓酶”江浙蝮蛇毒制成的,“江浙蝮蛇抗栓酶”和用五步蛇毒制成的“去纤酶”。     

玻璃体内注射清栓酶治疗实验性玻璃体积血

清栓酶可促进玻璃体内纤维蛋白凝血块溶解,我们制作新鲜及陈旧性兔眼玻璃体积血模型,将清栓酶、尿激酶及注射用水分别注入玻璃体腔内,观察眼底、测定玻璃体出血指数、FDP含量、进行3P 试验,结果发现清栓酶有治疗效果,同对照组相比统计学上有显著差异,同尿激酶相比无差异,且未发现有毒副作用。     

Inhibition of lipid peroxidation by antioxidants in the vitreous body during hemorrhage

The paper was to investigate the character of malonic dialdehyde content shifts in the vitreous body under the effect of potassium fenosane, oxipyridinchlorhydrate (OPChH), superoxidedismutase, sodium diethylditiokarbamat (DDTK), forming complex with copper under the experimental hemorrhage. Decrease in LPO speed shown after potassium fenosane administration was considerable under retrobulbar administration. More pronounced inhibition of LPO reaction under the hemorrhage was noted in combination of antioxidants with superoxidedysmutase.     

Birdshot retinochoroidopathy

Birdshot retinochoroidopathy is a rare bilateral ocular disorder which typically affects healthy, middle-age caucasians. The typical symptoms are recent onset of bilateral floaters with decreased vision in a white and quiet eye. Minimal anterior chamber reaction, vitreous infiltration without snowballs, and multifocal depigmented lesions in the outer retina and choroid are characteristic of birdshot retinochoroidopathy. Other associated findings include retinal vasculitis, paravascular hemorrhage, vitreous hemorrhage, cystoid macular edema, cellophane maculopathy, posterior subcapsular cataract, optic disc edema, vascular attenuation and tortuosity, optic atrophy and retinal or choroidal neovascularization. Management involves Amsler grid self-assessment and routine funduscopic examinations. A recently documented case of treatment with aromatic retinoids showed improvement while many other commonly prescribed medications are equivocal in effect. Laser photoablation or panretinal photocoagulation are recommended for treatable choroidal or retinal neovascularization, respectively.     

Features of lipid peroxidation in the vitreous body and retina during intravitreal hemorrhaging in dithiosone-induced diabetes]

It has been stated that in experimental dithiazone-induced diabetes lipid peroxidation is intensified in vitreous body and retina of the rabbits' eyes. The increase of LP in vitreous body and retina during intravitreal hemorrhage due to experimental diabetes was controlled by antioxidants.     

玻璃体视网膜手术治疗先天性视网膜劈裂及其并发症的临床疗效

目的:评价玻璃体视网膜手术治疗先天性视网膜劈裂及其并发症的临床疗效。方法:选择2009年1月-2012年1月于我院进行玻璃体视网膜手术的先天性视网膜劈裂患者30例(42只眼),患者均接受了闭合式睫状体经扁平部三切口入路保留晶状体的玻璃体切割手术,并分析其术前及术后情况。结果:先天性视网膜劈裂患者中发生孔源性视网膜脱离19眼,牵拉性视网膜脱离8眼,玻璃体积血10眼,同时伴有视网膜脱离和玻璃体积血有5眼;在末次随访时视力提高者有36只眼,占85.71%,无提高者有6只眼,占14.29%;术前平均视力为(0.15±0.09),末次随访时平均视力提高至(0.31±0.16),两者平均视力差异具有统计学意义(t=5.649,P0.001);42只眼视网膜解剖结构复位良好,视网膜平伏;OCT检查结果显示,末次随访时黄斑劈裂平均面积(0.22±0.18)mm2,与术前黄斑劈裂平均面积(1.07±0.52)mm2比较,差异有统计学意义(t=10.011,P0.001),黄斑微囊样改变有改善;随访期间5只眼出现并发症,占11.90%,其中2眼术后发生PVR且伴牵拉性视网膜脱离,2只眼发生白内障,1只眼出现玻璃体积血,术后视网膜解剖均复位良好。结论:玻璃体视网膜手术可以帮助患者进行视网膜解剖复位及提高其先天性视网膜劈裂患者视功能,具有良好的临床疗效。     

Cytologic findings in vitreous fluids. Analysis of 74 specimens

OBJECTIVE: To review the cytologic findings of vitreous specimens and propose a simplified approach to them. STUDY DESIGN: Seventy-four vitreous specimens from 60 patients obtained either during a pars plana vitrectomy or by vitreous aspiration were reviewed. Clinical correlation was obtained on all patients. RESULTS: Findings suggestive of a specific disorder were present in 30 specimens (41%); cytologic examination of the remaining 44 showed nonspecific changes. A lymphoproliferative disorder, the intraocular malignancy suspected most often in this series, was identified in eight specimens (11%). Large cell lymphomas were evident in 5 specimens, 2 specimens were suspicious for lymphoma, and 1 specimen was consistent with plasmacytoma. Twelve specimens (16%) contained hemorrhage. In rare instances, specific infectious agents, such as parasites (5%), bacteria (1%) and fungi (3%), could be identified. The diagnosis of viral infections required ancillary studies. Lens fragments were identified in four cases (5%), and a diagnosis of lens-induced endophthalmitis could be rendered in one case (1%). Changes consistent with sarcoidosis were present in 3% of cases. CONCLUSION: Based on this experience with vitreous specimens submitted for clinical reasons, we found that they could be divided into three broad diagnostic categories: inflammation/infection (54 specimens/41 patients), hemorrhage (12 specimens/12 patients) and malignancy (8 specimens/7 patients).     

Extracellular carbonic anhydrase mediates hemorrhagic retinal and cerebral vascular permeability through prekallikrein activation

Excessive retinal vascular permeability contributes to the pathogenesis of proliferative diabetic retinopathy and diabetic macular edema, leading causes of vision loss in working-age adults. Using mass spectroscopy-based proteomics, we detected 117 proteins in human vitreous and elevated levels of extracellular carbonic anhydrase-I (CA-I) in vitreous from individuals with diabetic retinopathy, suggesting that retinal hemorrhage and erythrocyte lysis contribute to the diabetic vitreous proteome. Intravitreous injection of CA-I in rats increased retinal vessel leakage and caused intraretinal edema. CA-I-induced alkalinization of vitreous increased kallikrein activity and its generation of factor XIIa, revealing a new pathway for contact system activation. CA-I-induced retinal edema was decreased by complement 1 inhibitor, neutralizing antibody to prekallikrein and bradykinin receptor antagonism. Subdural infusion of CA-I in rats induced cerebral vascular permeability, suggesting that extracellular CA-I could have broad relevance to neurovascular edema. Inhibition of extracellular CA-I and kallikrein-mediated innate inflammation could provide new therapeutic opportunities for the treatment of hemorrhage-induced retinal and cerebral edema.     

苏州市玻璃体积血的临床病因分析

目的:探讨苏州市不同年龄组玻璃体积血的常见病因,为疾病预防提供依据。方法:对在2009年~2011年住我院的287例295眼玻璃体积血患者的临床资料进行回顾性分析。结果:在所有玻璃体积血患者中,糖尿病性视网膜病变(diabetic retinopathy,DRP)111例(38.7%),眼外伤60例(20.9%),视网膜静脉阻塞(retinal vein occlusion,RVO)59例(20.6%),孔源性视网膜脱离(rhegmatogenous retinal detachment,RRD)32例(11.1%)。年龄<45岁的青年组中,眼外伤导致的玻璃体积血最多,为36例(48.6%),其次为DRP 26例(35.1%),视网膜血管炎(retinal vasculitis,RV)10例(13.5%)。45~59岁中年组中,DRP导致玻璃体积血最多,为61例(50.8%),其次为RVO 20例(16.7%)、眼外伤17例(14.2%)、RRD 16例(13.3%)。≥60岁老年组中,RVO导致玻璃体积血最多,为38例(40.9%),其次为DRP 24例(25.8%),RRD 15例(16.1%)。结论:DRP、眼外伤、RVO、RRD是引起玻璃体积血最常见的病因。青年患者的主要病因是眼外伤、DRP和RV,而中老年患者的主要病因是DRP及RVO。     

Dynamic Increase in Extracellular ATP Accelerates Photoreceptor Cell Apoptosis via Ligation of P2RX7 in Subretinal Hemorrhage

Photoreceptor degeneration is the most critical cause of visual impairment in age-related macular degeneration (AMD). In neovascular form of AMD, severe photoreceptor loss develops with subretinal hemorrhage due to choroidal neovascularization (CNV), growth of abnormal blood vessels from choroidal circulation. However, the detailed mechanisms of this process remain elusive. Here we demonstrate that neovascular AMD with subretinal hemorrhage accompanies a significant increase in extracellular ATP, and that extracellular ATP initiates neurodegenerative processes through specific ligation of Purinergic receptor P2X, ligand-gated ion channel, 7 (P2RX7; P2X7 receptor). Increased extracellular ATP levels were found in the vitreous samples of AMD patients with subretinal hemorrhage compared to control vitreous samples. Extravascular blood induced a massive release of ATP and photoreceptor cell apoptosis in co-culture with primary retinal cells. Photoreceptor cell apoptosis accompanied mitochondrial apoptotic pathways, namely activation of caspase-9 and translocation of apoptosis-inducing factor (AIF) from mitochondria to nuclei, as well as TUNEL-detectable DNA fragmentation. These hallmarks of photoreceptor cell apoptosis were prevented by brilliant blue G (BBG), a selective P2RX7 antagonist, which is an approved adjuvant in ocular surgery. Finally, in a mouse model of subretinal hemorrhage, photoreceptor cells degenerated through BBG-inhibitable apoptosis, suggesting that ligation of P2RX7 by extracellular ATP may accelerate photoreceptor cell apoptosis in AMD with subretinal hemorrhage. Our results indicate a novel mechanism that could involve neuronal cell death not only in AMD but also in hemorrhagic disorders in the CNS and encourage the potential application of BBG as a neuroprotective therapy.     

Comparison of Combined and Sequential Surgery for Proliferative Diabetic Retinopathy: A Single Surgeon Study

Purpose

To compare the results of combined and consecutive surgeries to treat proliferative diabetic retinopathy and cataract.

Methods

Retrospective comparative study. Forty-one patients with proliferative diabetic retinopathy (PDR) were enrolled. Twenty-nine eyes for the combined surgery group and twelve eyes for the sequential group were included. All surgeries were performed by one surgeon. Phacoemulsification was performed using a clear cornea incision. The vitrectomy was performed using a 20-gauge vitreous cutter.

Results

The best corrected visual acuity (BCVA) and intra- and post-operative complications were the main outcome measures. In the combined surgery group, the BCVA increased in 18 (62.1%) eyes, while eight (27.6%) eyes remained stable and three (10.3%) eyes decreased. Postoperative complications included fibrinous exudation in nine eyes, macular edema in three eyes and vitreous hemorrhage in three eyes. In the sequential surgery group, the BCVA increased in seven (58.3%) eyes, remained the same in four (33.3%) eyes and was reduced in one (8.3%) eye. Postoperative complications included macular edema in two eyes, neovascular glaucoma in two eyes and vitreous hemorrhage in one eye.

Conclusions

Both combined and sequential surgeries are safe and effective for treating PDR and cataracts. The combined surgery had a higher incidence of fibrinous exudation.