清栓酶(蝮蛇抗栓酶)的临床应用

THE CLINICAL APPLICATIONS OF QINGSHUANMEI (VIPER ANTITHROMBOTIC ENZYME)

清栓酶是第238医院与沈阳药学院合作,从中国东北陆生白眉蝮蛇毒中提取的一种酶制剂,经过一系列的药理实验证实,该药有降低血浆纤维蛋白源、血液粘度、血小板聚集功能及粘附率、溶栓、扩血管、改善微循环作用,从而有显著抗凝效应,治疗血栓病有效。该药急性毒性试验,半致死量(LD_(50)),静脉给药为3.75±0.84u/公斤,临床应用有效剂量为0.010～0.012u/公斤,相当小白鼠LD_(50)的1/200,安全系数为200倍,可认为是安全的。亚急性、慢性毒性试验证实,活疗剂量该药对心、肝、肾等功能无影响,对机体无害。该药药代动力学检查:半衰期为4小时,24小时90％从体内排出,48小时排完,主要由肾脏、消化道排泄,肝脏解毒。临床治疗观察50000余例,对闭塞性脑、心周围血管、眼底血管病等二十余个病症效果显著,其中脑血栓30000例,有效率为92.3％;脉管炎311例,有效率为96.6％;深部静脉炎118例,有效率为98％;冠心病159例,心绞痛有效率为96.2％心电图ST—T缺血性改变有效率为79.3％。经过临床系统观察目前对以下二十余个病症有较好的疗效。脑血栓,短暂性脑缺血发作(TIA)、脑动脉硬化及痴呆(近期)、震颤性麻痹;脉管炎、深部静脉炎、无脉症、雷诺氏病、上下腔静脉血栓、冠心病、心绞痛、心肌梗塞;眼底动静脉血栓、突发性耳聋;断肢(指)再植中抗凝、硬皮病、牛皮癣、皮肌炎、系统性红斑狼疮,干燥综合症、新生儿硬肿症、高凝血症、老年性糖尿病等。该药每日一次,每次按0.01～0.012u/公斤计算。成人一般0.5—0.75u/2—3支。用生理盐水或葡萄糖浠释,静脉给药,15～20天一疗程,停药3—7天可重复另一疗程。病重或病情特殊者可根据情况增减用量。该药无眩晕、复视等神经毒付反应,不降低血小板,治疗剂量无毒付作用。清栓酶是目前治疗血栓病疗效较高,起效快、付作用少等一种较理想的药物。

Qingshuanmei (viper antithromboticenzyme) is a joinl product of Hospital 238 and Shenyang College of Pharmacy, It is a prepartion of enzyme which is extracted from snake venom of the terrestrial whir browed viper found in North East China, A series of pharmacological experiments has confirmed its following actions: Reduction of plasma fibrinogen, blood viscosity, platelet aggregation and adhesion; thrombolysis, vasodilation and improvement of the microcirculation, Hence it has marked anticoagulation effect and is effective in thrombotic disorders. Acute toxicity tests show a LD_(50) of 3.75±0.84u/kg when given intravenously. The clinically effective dose is 0.01-0.012u/kg. which is equivalent being 200.The drug may thus be considered safe. Subacute and chronic toxicity tests have confirmed that therapeutic doses have nodeleterious effects on cardiac, hepatic and renal function and are quite harmless. Pharmacokinetic data are: half life 4 hours; 90％ excretion in 24 hours, complete excretion in liver, Clinical observations of its use in more than 50000 cases in the past several years have demonstrated marked efficacy in more than 20 occlusive cerebral, cardiac, peripheral, fundal and other vascular diseases, efficacy rates being 9.23％ in 30000 cases of de cerebral thrombosis, 96％ in 524 cases of vasculitis, 98％ in 218 cases of deep phlebitis, and in 159 cases of coronary heart disease, the efficacy rate for angina was 96.2％ while that for, ischacmic ST—T changes in the EKG was 79.3％ Systematic clinical observations to date show that it gives good results in more than 20 conditions listed below: cerebral thrombosis, temporary ischaemic attacks (TIA), cerebral arteriosclerosis and dementia, paralysis agitans. Also has some effect on the sequelae of cerebral haemorrhage of more than 2 months duration; vasculitis, deep phlebitis, pulseless disease, Laynaud's disease, syndrome of superior and inforior vena caval obstructions; coronary heart disease, angina pectoris myocardial inforction; fundal arterial and venous thrombosis, abrupt deafness; anticoagulation in replantation of ampututed fingers and toes, scleroderma, dermatomyositis, systemic lupus erythematosus, scleredema neonatorum, hypercoagulation states, senilediahetes etc. The drug is given intaravenously ifter dilution in normal saline or glucose solution. It is administered once daily in a dose of 0.01～0.012u/kg. The usual adult dose is 0.5～0.75u 2—3 ampoules). A course lasts 15—20 days and may be repeated after an interval of 3—7 days. synergism is seen when it is combined with low molecular weight dextan. The drug is free from neurotoxic side effects such as vertigo, diplopia etc, and it does not reduce the blood platelel counl. Therapeutic doses are devoid of toxic side effects. Qingshuanmei is presetly an ideal drug for thrombotic diseases, which is highly effective, acts rapidly and causes few side effects.