急性重症胆管炎与内毒素血症

测定23例急性重症胆管炎(ACST)患者血、胆汁内毒素浓度,分别为105.3±11.9pg/ml和135.2±17.8ng/ml.内毒素血症发生率为82.6％。血内毒素浓度与胆汁内毒素浓度显著相乡(r=0.5480,p<0.01),与胆管直径不相关(r=0.368,p>0.05);而与胆管内压力显著相关(r=0.680,P<0.01)。胆汁内毒素浓度与胆管直径相关(r=0.470,p<0.05),但与胆管内压力不相关(r=0.330,p>0.05)。肝内结石伴梗阻,血、胆汁内毒素浓度高于肝外结石伴梗阻痛例。休克时血内素素浓度明显升高。普通血液培养阳性结果与发生内毒素血症的符合率为75％。     

丹参滴注液细菌内毒素检查法的应用

目的建立丹参滴注液的细菌内毒素检查法。方法采用凝胶法,参照《中国药典》2005年版附录对丹参滴注液进行细菌内毒素检查的方法学研究。结果本品经4.8倍稀释(λ=0.25EU/ml)或9.6倍稀释(λ=0.125EU/ml)对细菌内毒素无干扰作用。结论用0.25EU/ml或0.125EU/ml的鲎试剂进行细菌内毒素检查是可行的。     

血清低浓度AFP放射免疫测定及其临床意义

采用AFP(RIA)药盒,用零标准品将20ng/ml标准品作倍比稀释得10ng/ml与5ng/ml两个新的标准品。灵敏度测定表明该药盒最小可测值低于4ng/ml。350例正常成人测定结果均低于5ng/ml。作者分别以<20ng/ml(目前通行的正常界限)和<5ng/ml(本实验正常范围)作为诊断阈值,对677例各种肝脏良、恶性疾病的AFP测定结果进行评价,并对3例PHC术后病人作长期低浓度AFP监测。结果表明以5ng/ml为正常阈值有利于PHC的早期诊断和术后复发监测。     

细菌内毒素法检查注射用奥扎格雷钠热原

【目的】研究细菌内毒素法检查注射用奥扎格雷钠热原。【方法】参照《中国药典》2000年版二部收载的细菌内毒素检查方法及指导原则进行干扰试验。【结果】注射用奥扎格雷钠在稀释至0.25 mg/ml时,对鲎试剂的凝集反应无干扰作用;采用灵敏度为0.5 EU/ml的鲎试剂可进行细菌内毒素检查。【结论】细菌内毒素法适用于注射用奥扎格雷钠的热原检查。     

胆囊内胆汁CEA含量与胆囊良恶性病的关系

针吸胆汁对36例胆囊病变患者测定CEA水平，结果胆囊癌的胆汁CEA含量在500ng/ml以上并经手术与病理证实。因此认为胆汁CEA含量对鉴别胆囊良恶性有较高辅助诊断。     

注射用头孢噻肟钠的细菌内毒素检测

目的：考察注射用头孢噻肟钠的细菌内毒素检查法的可行性。方法：干扰试验与对比试验。结果：1．0g/瓶的样品稀释100倍可用灵敏度为0.5EU/ml的鲎试剂作细菌内毒素检查，与家兔法对比试验结果一致。结论：可用细菌内毒素检查法代替家兔法对注射用头孢噻肟钠进行热原检查。     

碟脉灵注射液的细菌内毒素检查

目的 :对碟脉灵注射液进行细菌内毒素试验。方法 :选择一定灵敏度的鲎试剂在最大有效稀释范围内 ,考察在不同稀释度下该制剂的干扰作用。结果 :选用灵敏度为 0 2 5EU/ml的鲎试剂 ,将样品 1∶2稀释后无干扰作用。结论 :用鲎试验法可以对碟脉灵注射液进行细菌内毒素检查。     

阻塞性黄疸患者血清及胆汁细胞间粘附分子-1的测定

目的探讨血清及胆汁中细胞间粘附分子-1(sICAM-1、bICAM-1)在胆道阻塞性黄疸鉴别诊断中的价值.方法应用酶联免疫吸附分析测定24例胆道恶性肿瘤和21例胆道良性疾病患者sICAM-1和bICAM-1水平.结果24例恶性黄疸sICAM-1平均水平为(2343±1312)ng/ml,21例良性黄疸为(446±219)ng/ml,两组比较有极显著差异(P＜0.01);83%肿瘤患者sICAM-1＞1000ng/ml,而良性疾病患者全部低于1000ng/ml.bICAM-1水平两组间无显著差异.结论测定sICAM-1,当其水平＞1000ng/ml时,在阻塞性黄疸的鉴别诊断上有一定的临床价值.[     

白介素-1β对家兔内毒素休克血管钙敏感性的调节作用及与Rho激酶和PKC的关系

目的观察白介素-1β(IL-1β)对家兔内毒素休克及离体血管钙敏感性影响及与PKC、Rho激酶的关系。方法健康成年家兔35只,雌雄不拘,完全随机分为正常对照组,LPS30min组,LPS1h组,LPS2h组,LPS4h组,每组7只,经耳缘静脉注射1mg/kg LPS(O111∶B4)复制家兔内毒素休克模型,在给LPS后30min、1、2、4h取血清及肠系膜上动脉(superior mesenteric artery,SMA),用ELISA方法检测不同时相点血清中IL-1β的浓度;用离体血管环张力测定技术,测血管环钙敏感性的变化,分析其与血清IL-1β浓度的相关关系。另取家兔70只,采用随机数字表分为正常对照组,25ng/mlIL-1β组,50ng/ml IL-1β组,100ng/ml IL-1β组,150ng/ml IL-1β组,200ng/ml IL-1β组,200ng/ml IL-1β+PMA组,200ng/ml IL-1β+staurosporine组,200ng/ml IL-1β+AngⅡ组,200ng/ml IL-1β+Y27632组,每组7只。无菌条件下取正常家兔SMA,检测不同浓度重组人IL-1...     

注射用顺铂细菌内毒素检查法的建立

目的:建立注射用顺铂的细菌内毒素检查法.方法:参照中国药典2000年版检测细菌内毒素的凝胶法.结果:以氯化钠注射液溶解的注射用顺铂经细菌内毒素检查用水稀释4倍后对鲎试剂无干扰作用.结论:用灵敏度为0.5 Eu/ml的鲎试剂检测注射用顺铂的细菌内毒素是可行的,可以用细菌内毒素法取代家兔热原法.     

降低内毒素对大鼠肝肺综合征肺损伤的作用

目的:探讨氧氟沙星降低内毒素对大鼠肝肺综合征的肺损伤保护作用。方法:结扎SD大鼠胆总管,建立肝肺综合征(HPS)动物模型。将大鼠分成3组(每组10只),假手术组:分离大鼠胆总管,腹腔注射生理盐水2ml;HPS模型组:结扎大鼠胆总管,腹腔注射生理盐水2ml;氧氟沙星组:结扎大鼠胆总管后腹腔注射左旋氧氟沙星(20mg/kg体重)。6周后检测血清内毒素,血、腹水、胆汁培养需氧或厌氧菌,血气分析,测定门静脉压力,肺干重/湿重比,肺灌洗液和肺组织匀浆中髓过氧物酶含量及丙二醛浓度,并评价肺组织病理变化。结果:与HPS模型组比,氧氟沙星组血浆内毒素浓度显著下降[(59±6.2vs268±35.6)ng/L,P<0.01],门静脉压力[(19.28±2.3vs17.80±2.18)cmH2O,P<0.01]、肺组织肺干重/湿重比(5.1±0.7vs4.9±0.7,P<0.01)、肺髓过氧物酶[(0.40±0.10vs0.24±0.03)U,P<0.01]和丙二醛[(0.32±0.05vs0.22±0.03)μmol/L,P<0.01]含量均有显著降低,肺组织炎症改变明显减轻。结论:降低内毒素可以减轻肝肺综合征的肺损伤。     

Determination of plasma level of platelet activating factor in cirrhotic patients and its relation to endotoxemia]

The plasma levels of platelet activating factor (PAF) were measured in 27 decompensated cirrhotic patients and 11 controls, using platelet aggregation bioassay. At the same time, the levels of endotoxin were also measured. The results showed that the levels of plasma PAF in decompensated cirrhotic patients were higher than those in the controls (5.34 +/- 1.94 ng/ml:1.18 +/- 0.24 ng/ml, P less than 0.01), and were higher in the cirrhotic patients with endotoxemia than in those without endotoxemia (6.19 +/- 2.21 ng/ml:3.89 +/- 0.92 ng/ml, P less than 0.01). The level of plasma PAF is related significantly to the level of endotoxin (r = 0.67, P less than 0.01)). We conclude that plasma PAF is increased in cirrhotic patients, especially in those with endotoxemia, and PAF could be involved in the pathophysiological changes in endotoxemia and other complications of cirrhosis.     

淋巴引流及ω-3多不饱和脂肪酸干预对大鼠肠道缺血再灌注的影响

目的 观察大鼠肠道缺血再灌注(Ⅰ/R)损伤时肠淋巴液引流对高迁移率族蛋白1(HMGB1)、炎症因子和内毒素的影响以及ω-3多不饱和脂肪酸(ω-3 PUFA)干预的效果.方法 72只SD大鼠随机区组法随机分为单纯引流组、Ⅰ/R组、Ⅰ/R+引流组(每组8只)和胃造口组[正常饮食(N)组、普通肠内营养(EN)组、普通肠内营养加ω-3 PUFA(PUFA)3大组,每大组再根据是否行Ⅰ/R 和引流分为2组,每组8只].单纯引流组只引流180 mⅠn淋巴液不行Ⅰ/R损伤;Ⅰ/R、VR+引流组行肠系膜上动脉夹闭60 mⅠn再灌注120 mⅠn;Ⅰ/R+引流组同时行肠淋巴液引流180 mⅠn.胃造口组大鼠均先行胃造口手术,分别给予不同营养5 d后造模,各引流组同前进行肠淋巴液引流180 mⅠn.手术完毕后分别取血清和淋巴液,定量检测内毒素,酶联免疫吸附试验(ELⅠSA)定量检测炎症因子以及HMGB1.结果 Ⅰ/R+引流组淋巴液中内毒素、炎症因子以及HMGBl均高于单纯引流组[均P＜0.05,白细胞介素(ⅠL)-6(30±8)pg/ml比(20±6)pg/ml,内毒素(0 029±0.011)U/ml比(0 008±0 005)U/ml];Ⅰ/R+引流组血清中内毒素、炎症因子均低于Ⅰ/R组(均P＜0 05).在胃造口组中,N 组和EN组的淋巴液中肿瘤坏死因子(TNF)-α与HMGBl均高于PUFA组[(46±17)pg/ml、(54±16)pg/ml比(28±9)pg/ml,(4.8±1.6)ng/ml、(5.3±1.8)ns/ml比(3.0±1.0)ng/ml,均P＜0.05].PUFA(Ⅰ/R)组血清中内毒素、炎症因子以及HMGBl均低于N(Ⅰ/R)组(均P＜0.05),PUFA(Ⅰ/R+引流)组血清中TNF-α与HMGBl均低于N(Ⅰ/R+引流)组(均P＜0 05).结论 引流肠淋巴液能够降低肠道Ⅰ/R损伤时内毒素、炎症因子和HMGB1的水平,减轻大鼠肠道Ⅰ/R引起的损伤.ω-3PUFA的干预对于肠道Ⅰ/R引起的损伤有一定的保护作用,对于减轻炎症反应有积极作用.

Abstract：

Objective To investigate the effects of lymphatic drainage and ω-3 polyunsaturated fatty acid (ω-3PUFA) on high mobility group box 1 (HMGB1) , inflammatory cytokines and endotoxin in rats with intestinal ischemia-reperfusion (Ⅰ/R) injury. Methods A total of 72 SD rats were randomly divided into drainage-alone group, Ⅰ/R group, ischemia-reperfusion plus drainage (Ⅰ/R+D) group (n=8 each)and 3 groups with 16 rats undergoing gastrostomy in each group: normal diet (N) group, enteral nutrition (EN) group and enteral nutrition & ω-3PUFA (PUFA) group. And they were further divided into 2 subgroups (n=8). The rats in Ⅰ/R and Ⅰ/R+D groups were subjected to a 60-min ischemia follow by 120-min reperfusion injury of superior mesenteric artery. When the rats suffered Ⅰ/R injury, intestinal lymph was drained for 180 min in the Ⅰ/R+D group. The rats in the drainage-alone group received 180-min lymph drainage without Ⅰ/R injury. After 5 days with different nutrition regimes, the models were established similarly. The rats in the Ⅰ/R+D sub-groups were treated with intestinal lymph drainage for 180 min. The serum and lymph samples were collected post-operatively. Endotoxin was detected by a Limulus kit. The inflammatory cytokines and high mobility group box 1 (HMGB1) were analyzed by enzyme-linked immunosorbent assay (ELISA).Results Endotoxin, inflammatory cytokines and lymphatic HMGB1 of lymphatic in the Ⅰ/R+D group were higher than those in the drainage-alone group [all P＜0.05 , IL-6 :(30±8) pg/ml vs (20±6) pg/ml, endotoxin: (0.029±0.011) U/ml vs (0.008+0.005) U/ml].The serum levels of endotoxin and inflammatory cytokines in the Ⅰ/R+ D group were lower than those in the Ⅰ/R group (P＜0.05).The lymphatic levels of TNF-a (tumor necrosis factor-alpha) and HMGB1 in the N and EN groups were higher than those in the PUFA group[TNF-α: (46±17)pg/ml, (54±16)pg/ml vs(28±9) pg/ml, HMGB1: (4.8±1.6) ng/ml, (5.3±1.8) ng/ml, (3.0±1.0) ng/ml, all P＜0.05) ].The serum levels of endotoxin, inflammatory cytokines and HMGB1 in the PUFA(l/R) group were lower than those in the N(Ⅰ/R) group (F＜0.05).The levels of TNF-a and HMGB1 were lower in the PUFA (Ⅰ/R+D) group than those in the N(Ⅰ/R+ D) group (both P＜0.05).Conclusion Lymphatic drainage may reduce the levels of endotoxin, inflammatory cytokines and HMGB1 so as to alleviate the intestinal Ⅰ/R injury. The intervention of ω-3PUFA has some protective effect through relieving inflammation.     

内毒素刺激猪主动脉内皮细胞PGI_2生成

本文初步观察了 E Coli 内毒素对体外培养的猪主动脉内皮细胞 PGI_2生成的影响。结果发现内毒素显著刺激培养细胞 PGI_2的生成,并呈剂量(1—1000ng/ml)和时间(6—24小时)依赖性,但不同于其它刺激剂,内毒素的作用时间至少需要2小时以上。     

内毒素诱导正常人单核细胞活化中CD69、TNF-α、IL-6的表达变化及意义

目的探讨内毒素诱导正常人单核细胞活化时抗原分子CD69、肿瘤坏死因子-α．（TNF-α）、白细胞介素-6（IL-6）的变化及意义。方法采集10例健康人外周静脉血20ml,经乙二胺四乙酸（EDTA）抗凝。通过Fi—coll—Hvpaque联合PercoU分离液分离纯化单核细胞后体外培养,设未干预组为对照,实验组予内毒素分别刺激30min、1、2、4h后收集细胞与上清液。通过流式细胞术检测单核细胞表面CD69的阳性细胞百分比,Luminex方法检测上清液中TNF-α、IL-6的浓度。结果分离的单核细胞纯度达95．5％。单核细胞表面CD69的表达率在内毒素刺激2、4h分别为（25．1±1．8）％、（41．7±1．4）％,明显高于对照组[（22．1±1．4）％,P均〈0．05]。上清液中TNF-α在内毒素刺激2、4h分别为（453．6546±163．6168）pg／ml、（1633．7878±528．8399）pg／ml,明显高于对照组[（O．1191±0．2135）pg／m],P均〈0．051。内毒素刺激4h时IL-6为（1464．4510±488．3783）pg／m],明显高于对照组[（0．0539±0．0955）pg/ml,P〈0．051。结论CD69、TNF-α、IL-6的表达上调与内毒素诱导单核细胞的活化密切相关。     

Evaluation on Sensitivity of the Human Sperm Motility Assay for Detecting Endotoxin in Culture Medium

Objective To investigate the sensitivity of the human sperm motility assay for detecting endotoxin in culture mediumMaterials &. Methods Motile sperm were separated and exposed to different concentrations of endotoxin (0.5 ng/mL, 1ng/mL, 10ng/mL, 1000ng/mL, 10 000ng/ mL, and 50 000ng/mL), and sperm motility was determined after incubation. Effects of endotoxin on sperm motility in media without albumin were also examined. In addition, at the same concentrations of endotoxin (0. 5ng/mL, 1 ng/mL, and 10 ng/ mL ) , the sensitivity of the human sperm motility assay was compared to those of 1-cell and 2-cell mouse embryo bioassays.Results At levels of 0. 5ng/mL-1000ng/mL endotoxin in media with 2mg/mL albumin, sperm did not show significant change in motility during 24 h of incubation when compared with the control (P>0. 05). However, the sperm motility was significantly inhibited at endotoxin dosages of 10 000 and 50 000 ng/mL. In the absence of albumin supplementation, at endotoxin levels of 50 000ng/mL, a     

内毒素损伤的肺动脉内皮细胞对肺动脉平滑肌细胞增殖的影响及骨形态发生蛋白-2的干扰作用

目的探讨内毒素休克损伤的肺动脉内皮细胞对肺动脉平滑肌细胞增殖的影响及骨形态发生蛋白-2（BMP-2）的干扰作用。方法（1）内皮细胞条件培养液（EC—CM）制作：EC—CM1：用不含血清的DMEM培养基孵育融合成单层的肺动脉内皮细胞（PAEC）24h,收集上清培养液制成;EC—CM2：以终浓度为1μg／ml的内毒素孵育融合成单层的PAEC1h后用不含血清的DMEM培养基孵育24h收集上清培养液制成。（2）分组及指标观测：将贴块法培养的肺动脉平滑肌细胞（PASMC）分成5组,分别用EC-CM1、EC—CM2、EC—CM2＋BMP-2 1ng／ml、EC—CM2＋BMP—2 10ng／ml和EC-CM2＋BMP-2 100ng／ml孵育PASMC。使用BrdU法测定PASMC增殖率;流式细胞仪分析PASMC细胞周期的变化;3^H—TdR掺入实验检测DNA合成情况;RT—PCR检测细胞周期素D1（cyclinD1）mRNA的表达量;免疫印迹检测pSmad蛋白量及细胞周期素（CyclinD1）蛋白表达。结果与Ⅰ组比较,Ⅱ组引起PASMC增殖率升高,S期细胞百分比增加,DNA合成增加（P〈0．01）,同时,cyclinD1mRNA及蛋白表达增加（P〈0．01）,pSmad蛋白量两组差异无统计学意义（P〉0．05）;与Ⅱ组比较,Ⅲ组中上述各指标无明显变化（P〉0．05）,而Ⅳ组、Ⅴ组中PASMC增殖率显著下降,S期细胞百分比下降,DNA合成减少（P〈0．01）,同时cyclinD1mRNA及蛋白表达显著下降（P〈0．01）,pSmad蛋白量显著增加（P〈0．01）。结论EC—CM2诱导PASMC cyclinD1的高表达,促进PASMC增殖;BMP-2可以通过激活Smad1信号转导途径抑制EC—CM2培养的PASMC表达cyclinD1,进而抑制EC—CM2刺激引起的PASMC增殖．BMP2作用在1～100ng／ml浓度范围内呈剂量依赖性。     

内皮素及降钙素基因相关肽在感染性胆汁中的变化及意义

目的 :通过检测胆管结石病人胆汁中内毒素、内皮素 (ET - 1)和降钙素基因相关肽 (CGRP)的浓度及血浆ALT、AST、TB含量 ,探讨ET - 1、CGRP含量变化在胆管结石胆道感染病人肝脏损伤中的作用。方法 :选择胆管结石病人 5 0例 ,按临床感染症状轻重和手术时机分成择期手术组 (Ⅰ组 )和急症手术组 (Ⅱ组 )。另选择单纯性胆囊结石病人 2 0例为对照组 (control组 )。术中采取胆总管胆汁 ,检测胆汁内毒素、ET - 1、CGRP和血浆ALT、AST、TB的含量。结果 :检测发现胆管结石病人术中胆汁中内毒素、ET - 1、CGRP含量和血浆ALT、AST、TB的含量明显高于对照组。伴随胆道感染程度加重 ,胆汁中内毒素含量升高 ,胆汁中ET - 1、CGRP含量也显著升高 ,ET - 1含量Ⅱ组显著高于Ⅰ组 ,但CGRP含量Ⅰ组显著高于Ⅱ组。术中胆汁中内毒素含量分别与ET - 1、CGRP含量呈正相关。结论 :胆管结石病人胆道感染时 ,胆汁中内毒素对肝胆系统合成和释放ET - 1、CGRP有强烈的刺激作用。胆汁中ET - 1与CGRP的生理平衡失调 ,在胆管结石胆道感染病人肝脏损伤中可能起重要作用     

蛙皮素对梗阻性黄疸时肠道细菌移位的影响

目的:观察梗阻性黄疸大鼠肠道细菌移位状况及蛙皮素对肠道细菌移位的影响。方法:健康雄性Wistar大鼠40只,随机分成4组,空白对照组(n=10)、假手术组(n=10)、阻塞性黄疸组(n=10)、蛙皮素治疗组(n=10,30μg/kg.d),、、用生理盐水作对照。检测第10天各组静脉血内毒素水平、取静脉血、肠系膜淋巴结作细菌定性培养,并取腹水作细菌定量培养,同时测定末端回肠粘膜厚度和绒毛高度。结果:组静脉血内毒素(129.58±13.79)pg/ml较组(239.03±32.0)pg/ml明显降低(P<0.05),组静脉血、肠系膜淋巴结细菌培养阳性率较组明显降低(P<0.05),组腹水作菌落集数(113.67±8.0)CFU/ml较组(363.19±15.1)CFU/ml明显降低(P<0.05),组回肠末端粘膜厚度和绒毛高度较组明显增加(P<0.05)。结论:蛙皮素可保护梗阻性黄疸时小肠粘膜屏障功能,减少肠道细菌易位和内毒素血症。     

Effects of activated protein C on coagulation and fibrinolysis in rabbits with endotoxin induced acute lung injury

Background Sepsis induced acute lung injury （ALI） as a common syndrome in clinical practice has a high mortality. Recombinant human activated protein C （APC） can significantly reduce the mortality of patients with severe sepsis. Several studies have implicated that APC may be protective in ALI. Methods Twenty-one rabbits were operatively prepared and randomly divided into sham, control, or APC groups （n=7 in each group）. After a tracheotomy had been performed, ALI was produced in the control and APC groups by infusion of Escherichia coil endotoxin 100 μg/kg per hour intravenously for 1 hour. The sham group received only the vehicle, infusion of 20 ml of 0.9% saline. The rabbits were studied under anesthesia for 6 hours and were ventilated with 40% oxygen. Bovine APC （25 μg·kg^-1·h^-1） was intravenously administered. The infusion was initiated half an hour post-injury and lasted for 4 hours. The animals were resuscitated with Ringer＇s lactate solution. Results In comparison with nontreatment in the control group, the infusion of APC significantly reduced the increase of thrombomodulin level （TM; control group was （0.68±0.06） ng/ml, vs APC group of （0.62±0.07） ng/ml at 6 hours, P 〈0.05）, and significantly attenuated the fall in protein S （PS; control group was （2.32±0.03） μg/ml at 2 hours, （2.24±0.06） μg/ml at 4 hours and （2.21±0.09）μg/ml at 6 hours, vs APC group （2.46±0.04） μg/ml at 2 hours, （2.40±0.05） μg/ml at 4 hours and （2.39±0.07） μg/ml at 6 hours, P 〈0.01）. In addition, APC limited the increase in plasminogen activator inhibitor-1 （PAI-1） both in plasma （control group was （0.68±0.12） ng/ml at 1 hour, （0.84±0.06） ng/ml at 2 hours, （0.87±0.08） ng/ml at 4 hours and （0.91±0.05） ng/ml at 6 hours, vs APC group （0.42±0.16） ng/ml at 1 hour, （0.43±0.04） ng/ml at 2 hours, （0.45±0.09） ng/ml at 4 hours and （0.45±0.14） ng/ml at 6 hours, P 〈0.01） and in bronchoalveolar lavage fluid （at 6 hour