革兰氏阴性菌菌血症患者的内毒素血症诊断依赖于细菌种类：临床研究的荟萃分析。
Diagnosis of endotoxemia with gram-negative bacteremia is bacterial species dependent: a meta-analysis of clinical studies.
机构信息
School of Rural Health, University of Melbourne, Melbourne, Australia.
出版信息
J Clin Microbiol. 2009 Dec;47(12):3826-31. doi: 10.1128/JCM.01189-09. Epub 2009 Sep 30.
Endotoxemia is undetectable for up to 60% of cases of bacteremia caused by gram-negative (GN) species, a discordance attributed to the limitations of the Limulus assay for endotoxemia. The lipid A structure of the endotoxin molecule is critical for the sensing of GN bacteria by the host immune system although not so for sensing by the Limulus assay. The lipid A structure of commensal Enterobacteriaceae is hexa-acyl, whereas non-Enterobacteriaceae have a broader range of structures. By using a previously published classification of lipid A structures (R. S. Munford, Infect. Immun. 76:454-465, 2008), the association of endotoxemia with bacteremia caused by GN organisms is reexamined for 580 GN bacteremic patients from 46 studies. Endotoxemia was less commonly detected for cases of bacteremia caused by Salmonella enterica serovar Typhi (four studies; 15 of 55 cases of bacteremia [27%]) than for cases of bacteremia caused by Neisseria meningitidis (five studies; 69 of 84 cases [82%]) and Pseudomonas pseudomallei (one study; 38 of 41 cases [93%]) among studies restricted to those with specified cases of bacteremia caused by GN organisms. Among 23 unrestricted studies, endotoxemia was less commonly detected for cases of bacteremia with a commensal member of the Enterobacteriaceae (104 of 240 cases [43%]) than with non-Enterobacteriaceae (59 of 100 cases [59%]) (summary odds ratio, 0.53 [90% confidence interval, 0.33 to 0.85]). This finding is consistent across all the unrestricted studies, even including studies with seemingly contrary results for endotoxemia diagnosis among cases of bacteremia caused by GN bacteria overall. Surprisingly, with bacteremia caused by commensal Enterobacteriaceae, the diagnosis of endotoxemia appears to be unrelated to the Limulus assay sensitivity. Across these 45 studies, the association of endotoxemia with GN bacteremia is variable but consistent for different types of GN bacteremia.
内毒素血症在高达 60%由革兰氏阴性（GN）物种引起的菌血症病例中无法检测到，这种不一致归因于内毒素血症鲎试验的局限性。尽管鲎试验不能检测到，但内毒素分子的脂质 A 结构对于宿主免疫系统识别 GN 细菌至关重要。共生肠杆菌科的内毒素脂质 A 结构为六酰基，而非肠杆菌科的结构范围更广。通过使用先前发表的脂质 A 结构分类（R. S. Munford，Infect. Immun. 76：454-465，2008），重新检查了 46 项研究中的 580 名 GN 菌血症患者的 GN 生物体引起的菌血症与内毒素血症的关联。在仅限于特定 GN 生物体引起的菌血症病例的研究中，与脑膜炎奈瑟菌（五研究；84 例菌血症中的 69 例 [82%]）和类鼻疽伯克霍尔德菌（一研究；41 例菌血症中的 38 例 [93%]）引起的菌血症相比，沙门氏菌肠炎血清型 Typhi（四研究；55 例菌血症中的 15 例 [27%]）引起的菌血症中内毒素血症的检测频率较低。在 23 项无限制的研究中，与非肠杆菌科（100 例菌血症中的 59 例 [59%]）相比，肠杆菌科共生成员引起的菌血症（240 例菌血症中的 104 例 [43%]）中内毒素血症的检测频率较低（汇总优势比，0.53 [90%置信区间，0.33 至 0.85]）。即使包括所有 GN 细菌引起的菌血症中内毒素血症诊断似乎相反的研究，这一发现也适用于所有无限制的研究。令人惊讶的是，对于由共生肠杆菌科引起的菌血症，内毒素血症的诊断似乎与鲎试验的敏感性无关。在这 45 项研究中，内毒素血症与 GN 菌血症的关联因不同类型的 GN 菌血症而有所不同，但始终一致。
Zotero 插件