Clinical Study Of The Changes Of Sero-enzyme And C-Reactive Protein In Patients Bitten By Agkistrodon Halys

Objective: To investigate the changes of serum marker levels,including alanin aminotransferase (ALT) , aspartate aminotranferase (AST),lactic dehydrogenase (LDH),creatine kinase (CK),and C-reactive protein level(CRP) in patients bitten by agkistrodon halys , to explore the relationship between serum marker level and degree of disease severity, visit timing as well as incidence of complications , and to analyze the role of of serum marker level in estimation of degree of disease severity and prognosis.Methods: According to clinical classification and severity degree score standard of venomous snake bitting, patients bitten by agkistrodon halys were divided into three types according to toxical degree on admission : mild , severe and critical type , respectively . Serum marker levels in patients in three types were compared. Patients were divided into two groups based on SIRS diagnostic criteria suggested by ACCP/SCCM : SIRS group and non-SIRS group, respectively. Serum marker levels in patients in SIRS group and non-SIRS group were compared. Patients were divided into two groups based on MODS diagnostic criteria :MODS group and non-MODS group, respectively. Serum marker levels in patients in MODS group and non-MODS group were compared. Patients were divided into three groups based on visit timing: A group (0～12h after bite),B group (12～24h after bite) and C group ( >24h after bite).Degree of disease severity and incidence of complications were compared in patients in A, B, and C group .Results: There was significant difference in serum marker levels between mild , severe and critical type(P<0.05). There was significant difference in serum marker levels between SIRS group and non-SIRS group ( P < 0.05).There was significant difference in serum marker levels between MODS group and non-MODS group(P<0.05).Incidence of MODS in SIRS group was higher than in non-SIRS group .There was significant difference in incidence of MODS between SIRS and non-SIRS(χ2 =19.73, P<0.001).The later visit timing (12～24h after bite and >24h after bite),the more cases of severe and critical type(χ2=23.29,P<0.001) , and the higher incidence of SIRS and MODS(χ2 =14.03,P<0.01;χ2 =25.01,P<0.001respectively).Conclusion:1. The severer degree of disease condition in patients bitten by agkistrodon halys , the higher Serum levels of markers.2. When the patients bitten by agkistrodon halys complicate SIRS, serum CRP may markedly rise, incidence of MODS may increase, degree of disease severity may exacerbate .3. The serum enzyme levels in the patients bitten by agkistrodon halys are clearly associated with occurrence of SIRS and MODS.