Department of Clinical Microbiology and Infectious Diseases, Brighton and Sussex Medical School, Brighton and Sussex University Hospitals Trust, UK.
Lancet Infect Dis. 2011 Jan;11(1):65-71. doi: 10.1016/S1473-3099(10)70220-6.
A substantial body of experimental and clinical evidence suggests that neutralising or removing lipopolysaccharide endotoxin would be an effective adjunctive approach to the management of Gram-negative sepsis. Polymyxins are a group of cyclic cationic polypeptide antibiotics. Although they have useful antimicrobial activity against Gram-negative bacteria, their clinical use has been limited because of toxicity. However, in addition to their antimicrobial property, polymyxins can bind to and neutralise endotoxin. Thus, investigators have explored the possibility of using polymyxin bound to a solid-phase carrier for specific haem-adsorption in patients with sepsis, thereby retaining the lipopolysaccharide-binding properties but minimising systemic toxic effects. This system has been widely used in Japan for many years, but convincing clinical evidence of efficacy is lacking. A recent Italian study has some promising data. Although polymyxin has been the principal agent used to explore this approach, other molecules have the ability to bind endotoxin, and some of these have very recently been proposed as the basis for other endotoxin-removal devices. The available evidence is reviewed to assess the potential use of such devices in clinical practice.
大量的实验和临床证据表明，中和或去除脂多糖内毒素将是治疗革兰氏阴性菌败血症的一种有效辅助方法。多粘菌素是一类环状阳离子多肽抗生素。尽管它们对革兰氏阴性菌具有有用的抗菌活性，但由于其毒性，其临床应用受到限制。然而，除了其抗菌特性外，多粘菌素还可以与内毒素结合并中和内毒素。因此，研究人员探索了将多粘菌素与固相载体结合，用于败血症患者特定的血红素吸附的可能性，从而保留内毒素结合特性，但最大限度地减少全身毒性作用。多年来，这种系统在日本得到了广泛应用，但缺乏令人信服的疗效临床证据。最近的一项意大利研究提供了一些有希望的数据。尽管多粘菌素一直是用于探索这种方法的主要药物，但其他分子也具有结合内毒素的能力，其中一些最近已被提议作为其他内毒素去除装置的基础。本文回顾了现有证据，以评估此类设备在临床实践中的潜在用途。
