Sakamoto Yuichiro, Mashiko Kunihiro, Obata Toru, Yokota Hiroyuki
Department of Emergency and Critical Care Medicine, Graduate School of Medicine, Nippon Medical School.
J Nippon Med Sch. 2010 Apr;77(2):119-22. doi: 10.1272/jnms.77.119.
The limulus test, which has been established as a test for endotoxin measurement, is associated with problems, including that posed by the presence of a response inhibitor factor and the longer time needed for the measurement of low concentrations. On the other hand, the technique of direct hemoperfusion with a polymyxin B immobilized fiber column (DHP-PMX) was developed in Japan in 1994 and has been used for the control of endotoxemia in septic shock. The limulus test, which is a common endotoxin measurement test, has several problems with regard to sensitivity. Therefore, this test is no longer used to determine the effectiveness of DHP-PMX. Here, we describe a patient presenting with colonic perforation who recovered from septic shock with DHP-PMX. This treatment effect was reflected by a decrease in plasma endotoxin levels as demonstrated more readily with endotoxin scattering photometry assay than with the standard limulus test. We conclude that endotoxin measurement with endotoxin scattering photometry is superior to nephelometry in patients with endotoxemia.
鲎试剂检测已被确立为一种用于测量内毒素的检测方法，但它也存在一些问题，包括存在反应抑制因子带来的问题以及测量低浓度内毒素所需时间较长。另一方面，1994年日本研发了用多粘菌素B固定化纤维柱进行直接血液灌流（DHP-PMX）的技术，并已用于控制脓毒性休克中的内毒素血症。鲎试剂检测作为一种常见的内毒素测量检测方法，在灵敏度方面存在几个问题。因此，该检测不再用于确定DHP-PMX的有效性。在此，我们描述了一名患有结肠穿孔的患者，他通过DHP-PMX从脓毒性休克中康复。这种治疗效果通过血浆内毒素水平的降低得以体现，与标准鲎试剂检测相比，内毒素散射光度测定法能更直观地显示这一点。我们得出结论，在内毒素血症患者中，用内毒素散射光度测定法测量内毒素优于比浊法。
