牛磺酸对内毒素和内皮素促进肠道内毒素转运的拮抗作用

牛磺酸对内毒素和内皮素促进肠道内毒素转运的拮抗作用北京医科大学生理学教研室王伟阳，唐朝枢机体严重应激损伤时常发生肠源性内毒素血症，使病程发展复杂化和恶化。由于肠源性内毒素血症的发生机理目前尚未完全阐明，临床上仍缺少有效的防治措施。牛磺酸（ｔａｕｒｉｎ...     

纳洛酮对内毒素血症脑组织保护及微循环影响的实验研究

有研究表明，纳洛酮对内毒素引起的脑组织损害、微循环障碍、心肌缺血、呼吸功能障碍、肠黏膜病变和代谢异常等有保护作用，其机制可能和内啡肽及炎症介质有关。但尚未见纳洛酮对炎症介质和微循环影响的详细报道。本实验观察大鼠的血液炎性介质、脑组织病理和肠系膜微循环变化，及纳洛酮对内毒素血症病理变化的影响，以探讨纳洛酮在内毒素血症中发挥的保护作用。     

复方中药制剂治疗内毒素血症进展

回顾现代医学对内毒素血症的种种治疗措施,尽管各种广谱高效的抗生素能杀灭细菌,但同时引起革兰阴性杆菌大量释放内毒素,而内毒素在引起全身炎症反应综合症,感染性休克,多器官功能障碍中发挥主要作用,导致治疗失败;而对抗性干预内毒素及其诱发的炎症介质（如TNF—α和IL-1）治疗内毒素血症似乎理所当然,但疗效不确切且进展甚微。中医药以其可多途径、多环节、多靶点发挥作用的特点,治疗内毒素血症有一定的成效。     

氨基胍对内毒素休克大鼠肝脏功能的保护作用

目的 :探讨诱导型一氧化氮合酶 ( i NOS)抑制剂氨基胍 ( AG)对内毒素休克时肝损伤的治疗作用。方法 :雄性 Wistar大鼠 32只 ,随机分为正常对照组、内毒素对照组、去甲肾上腺素治疗组和氨基胍治疗组 ,每组各 8只。用大肠杆菌内毒素 ( LPS)复制大鼠内毒素性休克模型 ,分别给予去甲肾上腺素 ( NA)和 AG治疗 ,观察各组平均动脉压 ( MAP)、心率 ( HR)及肝脏功能的变化。结果 :AG( 2 0 mg.kg-1)能使血压在 5 0 min后恢复至基础水平 ,并且能够减轻内毒素血症导致的血浆 GOT和 GPT水平增高。结论 :AG可能成为治疗内毒素休克的一种新途径     

加减清营汤治疗乙肝后肝硬化内毒素血症热毒血瘀型的临床研究

目的 研究加减清营汤对乙肝后肝硬化内毒素血症患者体内的内毒素水平的影响。方法 58例确诊的乙肝后肝硬化内毒素血症热毒血瘀型患者随机分为治疗组30例,对照组28例。对照组给予还原型谷胱甘肽、苦黄注射液、甘草酸二胺氯化钠保肝治疗,治疗组在对照组治疗基础上给予加减清营汤治疗。用动态浊度法检测58例乙肝后肝硬化患者血清内毒素水平,并测定血清丙氨酸氨基转移酶（ALT）、总胆红素（TBiL）及凝血酶原时间（PT）等。结果 在临床症状积分改善方面治疗组优于对照组（P<0.01）,对内毒素水平的改善,治疗组优于对照组（P<0.05）。结论 加减清营汤对乙肝后肝硬化内毒素血症疗效显著。      

内毒素血症早期治疗的基础研究

内毒素血症是现代急诊医学面临的一个常见而复杂的难题，应在其发病早期给予干预以阻止病情进一步发展为内毒索休克和多器官功能障碍综合征。根据内毒索血症发生的病理机制，内毒索血症的早期治疗措施包括：（1）抑制内毒素合成和释放；（2）促进内毒素的灭活和排出；（3）减少肠道内毒素的产生和吸收；（4）拮抗及中和内毒素；（5）阻断内毒素与受体结合；（6）阻断内毒素细胞内信号转导通路；（7）抑制炎症介质的作用。探索更加合理、有效干预治疗方法的研究仍在继续。     

鲎试验的研究进展和展望

一、导言内毒素(Endotoxin)源于革兰氏阴性菌的胞壁外层,广泛散在于自然界和人类环境中,具有多种生物学活性。生物体对内毒素的高度敏感性,以及内毒素在革兰氏阴性菌感染病因上所起的重要作用,促使人们不断地探索具有灵敏性、特异性、能准确定量内毒素的方法。鲎(Limulus)是一种有四亿年历史的     

血液灌流用内毒素吸附剂的研究进展

一、内毒素及内毒素血症内毒素(endotoxin)是革兰阴性(G-)细菌的细胞外壁溶解后释放出的脂多糖(LPS)。细菌释放出大量内毒素至血液可引发内毒素血症。内毒素血症进入血液后引起一系列反应,最终导致器官坏死、不可逆休克和死亡,目前临床上尚无有效的治疗方法。二、内毒素血症的治疗现状近些年,国内外学者试图利用抗生素、抗内毒素     

山莨菪碱对内毒素狗全血乳酸、肝糖原含量的影响

在观察山莨菪碱(654-2)对内毒素狗血流动力学指标影响的同时,观察了654-2对其动脉全血乳酸、血浆葡萄糖及肝细胞糖原含量的影响。实验结果;实验组(内毒素加654-2)动物高乳酸血症下降速度较对照组(内毒素加生理盐水)显著增快;注内毒素后第6h,肝糖原含量较对照组显著增高,而两组动物血流动力学指标变化无明显差异。提示654-2有改善内毒素狗肝脏对乳酸的糖异生作用,而这一作用似与血流动力学指标的改善关系不大。654-2对肝细胞的保护作用可能是其作用环节之一。     

大承气汤与多脏器功能障碍综合征

介绍多脏器功能障碍综合征;内毒素与多脏器功能障碍综合征的关系;中医中药对内毒素的清除作用;以及大承气汤治疗多脏器功能障碍综合征的基本情况和临床存在问题。     

肝硬化大鼠肠源性内毒素血症的程度及肝组织中内毒素的分布

目的 观察ＣＣｌ４所致中晚期硬化大鼠肠源性内毒素血症的程度及肝组织内毒症的分布。材料与方法 采用鲎三肽基质法测定腹主动脉及门静脉血浆内毒素含量;同时,采用免疫组化方法对肝硬化组织内毒素的分布进行观察。结果 ＣＣｌ４所致肝硬化动物血浆内毒素含量明显高于正常,尤以动脉内毒素含量增加而显著;同时,大部分肝脏组织呈内毒素染色阳性,内毒性主要分布于变性之肝细胞浆内,呈中度阳性染色。结论 ＣＣｌ４所致肝硬化伴     

温病湿热证病理造型及实验研究

本文介绍利用多因素,包括模拟湿热气候环境,过食肥甘及内毒素感染等综合复制的家兔温病湿热证动物模型的方法,造型动物出现诸如发热、纳呆、不欲饮水、便软烂或溏、嗜睡懒动、舌苔白腻等表现,与临床所见该证的主要症状体征和病理变化相符合,中药反证也提供了支持的佐证;实验进而发现模型动物造型后6小时及10小时的血浆内毒素水平较单纯用内毒素致热的发热对照组为高(p<0.05),提示温热造型动物内毒素廓清较为缓慢。可见,本实验将为以后研究温病湿热证提供较为理想的动物病理模型。     

血小板活化因子拮抗剂对急性出血坏死性胰腺炎大鼠内毒素血症防治作用实验研究

采用去氧胆酸逆行胰管内注射法复制急性出血坏死胰腺炎（简称ＡＨＮＰ）大鼠模型，观察血小板活化因子（ＰＡＦ）拮抗剂对ＡＨＮＰ大鼠内毒素血症的防治作用。结果显示：ＡＨＮＰ后，血中ＰＡＦ和内毒素水平明显升高，两者呈正相关关系。应用ＰＡＦ拮抗剂后，ＰＡＦ和内毒素水平明显下降，同时也明显减轻了ＡＨＮＰ大鼠胰腺和肠粘膜的损害。实验结果提示，ＰＡＦ参与了ＡＨＮＰ大鼠内毒素血症的发病过程，应用ＰＡＦ拮抗剂对ＡＨＮＰ大鼠内毒素血症有良好的防治作用。     

Regional changes in cerebral blood flow during acute endotoxemia

Summary Endotoxin has been shown to deteriorate autoregulation of Wood flow in liver, kidney and splanchnic organs. Despite frequently observed early changes in mental status in septic patients, regional cerebral blood flow (rCBF) has not been studied during the initial phase of endotoxemia. In 10 barnraised pigs, hyperdynamic endotoxemia was induced by continuous i.v. infusion of S. abortus equi endotoxin (total dose 13 μg/kg). A fall in pulmonary capillary wedge pressure (PCWP) was prevented by controlled infusion of Dextran 60. Arterial PCO₂ was maintained at 40 mmHg by adapting the tidal volume of the respirator. Central hemodynamics, ventilatory parameters and rCBF (quantified by means of radioactively labeled microspheres ?15 μm) were measured before and 30, 90 and 150 min after endotoxemia. Furthermore, the concentration of endotoxin in the plasma was quantified using chromogenic substrate (Limulus A moebocyte Lysate Test). Despite a significant drop in mean aortic pressure from 128 to 78 mmHg within 90 min of endotoxemia, the blood flow in cerebral cortex, medulla, nucleus caudatus, brain stem lamina quadrigemina and cerebellum remained within the control range. rCBF was independent of the actual concentration of endotoxin in the plasma. In contrast, deterioration of microcirculatory perfusion was observed in myocardium and kidney. We are led to conclude that the autoregulation of rCBF is maintained during the initial phase of endotoxemia. The results of the present study suggest that brain vessels respond differently to endotoxin or endotoxin-released mediators from visceral vessels.     

温病血浆内毒素与白细胞变化的相关性研究

温病患者血浆内毒素与白细胞变化的研究结果表明,血浆内毒素与白细胞总数(r=0.467)及中性粒细胞(r=0.631)呈中度正相关关系。白细胞总数及中性粒细胞是机体感染轻重的反映,与血浆内毒素一样,可作为温病毒的客观指标。     

Effect of da cheng qi decoction co. on endotoxemia in obstructive jaundice]

The role of da cheng qi decoction co. (DCQDC) in preventing endotoxemia in obstructive jaundice has been investigated. A prospective study was performed on 43 consecutive patients with obstructive jaundice undergoing surgery. 24 patients were given oral DCQDC before operation and were compared with 19 jaundiced control patients and 17 non-jaundiced control patients. The incidence of endotoxemia was reduced in perioperative portal (P less than 0.05) and postoperative systemic (P less than 0.01) blood samples in the DCQDC treated group, and a significant fall of the postoperative 24h creatinine clearance (P less than 0.01) and the plasma fibronectin level (P less than 0.01) occurred in jaundiced controls compared with the DCQDC treated group. DCQDC may reduce endotoxin absorption by a reduction or alteration of gut flora thereby reducing the endotoxin pool available for absorption as well as by a direct effect on endotoxin. Result of this study indicated that DCQDC had a beneficial effect on endotoxemia or outcome in obstructive jaundice.     

Preventively enteral application of immunoglobulin enriched colostrums milk can modulate postoperative inflammatory response

Several studies demonstrated acute inflammatory response following traumatic injury. Inflammatory response during surgical interventions was verified by a significant increase of endotoxin plasma levels and a decrease of the endotoxin neutralizing capacity (ENC). However, the incidence of elevated endotoxin levels was significantly higher (89%) than detected bacterial translocation (35%). Thus parts or products of Gram-negative bacteria seem to translocate more easily into the blood circulation than whole bacteria. Along with the bacterial translocation, the inflammatory response correlated directly with the severity of the surgical intervention. In comparison after major and minor surgery Interleukin-6 (IL-6) and C-reactive protein (CRP) was also significantly different. Similar effects in mediator release were shown during endovascular stent graft placement and open surgery in infrarenal aortic aneurysm. Open surgery demonstrated a significant stronger endotoxin translocation and a decrease of ENC. Strategies to prevent translocation seem to be sensible. Colostrum is the first milk produced by the mammary glands within the first days after birth. It contains a complex system of immune factors and has a long history of use in traditional medicine. Placebo-controlled studies verified that prophylactic oral application of immunoglobulin-enriched colostrum milk preparation diminishes perioperative endotoxemia, prevents reduction of ENC and reduces postoperative CRP-levels, suggesting a stabilization of the gut barrier. This effect may be caused by immunoglobulin transportation by the neonatal receptor FcRn of the mucosal epithelium.In conclusion, there is an association of perioperative endotoxemia and the subsequent increase in mediators of the acute phase reaction in surgical patients. A prophylactic oral application of colostrum milk is likely to stabilize the gut barrier i.e. reduces the influx of lipopolysaccharides arising from Gram-negative bacterial pathogens and inhibits enterogenic endotoxemia. This appears to be a major mechanism underlying the therapeutic effect in patients at risk for Gram-negative septic shock.     

人血浆高密度脂蛋白对大鼠内毒素血症的治疗作用初探

目的：观察人血浆高密度脂蛋白（HDL）对大鼠内毒素血症的治疗效果。方法：采用鲎试剂法和放射免疫分析法测定对照组（仅静脉输注内毒素（500EU/kg)]和治疗组[(血压下降后给予HDL（75mg/kg)治疗]大鼠血压，存活时间，血浆内毒素水平和肿瘤坏死因子（TNF）浓度，结果：与对照组比较，输液HDL后治疗组大鼠血浆TNF浓度明显降低（P＜0．05），血压下降程度明显减弱（P＜0．01），存活时间明显延长（P＜0．01），但两组大鼠血浆内毒素水平在各时点均无明显变化（P＞0．05），结论：人血浆HDL不但可以抑制TNF的释放，而且还能提高机体对抗内毒素损伤的能力，对内毒素血症具有较理想的治疗作用，其机理可能与HDL能抑制TNF释放有关。     

内毒素、TNF-α、IL-6在慢性肝炎中的作用研究

目的研究内毒素血症与慢性肝炎的关系,探讨内毒素在慢性肝炎中的作用机理.方法收集如下血标本正常健康献血员30例,慢性乙型肝炎患者30例,慢性深度黄疸乙型肝炎患者60例.采血当日送检功能.分别用鲎实验改良基质法进行内毒素定量测定,放射免疫方法(RIA)测定肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6).结果内素素、TNF-α、IL-6和总胆红素(TBIL)水平在三组患者中依次升高,各组两两比较,其差异有显著性意义(P＜0.01);四项指标进行直线相关性分析,各指标之间呈正相关关系(P＜0.01).结论内素素血症与肝脏损害的严重程度有关;内毒素可能主要是通过引起以下TNF-α为主的细胞因子水平的升高发挥肝脏损害作用的.     

Effect of Dachengqi Granules(大承气汤颗粒剂)on Level of Endotoxin in Enterogenous Endotoxemia in Rats

Objective:To study the effect of Dachengqi Granule (DCQG) on endotoxin level in rats ofenterogenous endotoxemia. Methods: Enterogenous endotoxemia model of rats was made by peritoneal in-jection of E. coli. In the treated groups, the rats were treated with different doses of DCQG, cefaclor andDCQG plus cefaclor respectively, starting from 3 days before to 1 day after modeling. Endotoxin levels inplasma, urine and stool were determined and compared. Results: Except for the cefaclor group, the plasmaand urine endotoxin levels in the treated groups were lower significantly (P＜0.05), while the endotoxinlevel in stool was obviously higher than that in the untreated model group. Conclusion: DCQG has the intes-tinal barrier protective effect including anti-bacteria, anti-inflammation and clearing endotoxin.