Department of Nephrology, Ospedale San Bortolo, Vicenza, Italy.
Blood Purif. 2014;37 Suppl 1:5-8. doi: 10.1159/000356831. Epub 2014 Jan 20.
One of the key molecules involved in the pathogenesis of severe sepsis and septic shock is lipopolysaccharide (LPS) or endotoxin, which is a component of the cellular wall of Gram-negative bacteria. Clinical studies have shown that the level of circulating LPS is correlated with illness severity (APACHE II), the onset and amount of organ dysfunction (SOFA) and intensive care unit mortality. Many therapeutic strategies have attempted to neutralize the pathogenic activity of endotoxin in order to interrupt the progression of a septic state towards a worsened clinical framework, i.e. severe sepsis of septic shock. Over the past decades the role of extracorporeal hemoperfusion by means of polymyxin B-based cartridges (PMX-DHP) to bind and neutralize LPS from whole blood has increased in clinical relevance. This is due to an increasing number of studies confirming that a directed therapy of endotoxic shock could significantly influence the course of the septic cascade. This review will outline the meaning of the targeted approach to endotoxin, both highlighting the specific immunologic effect of endotoxin removal by polymyxin B and the evidence of clinical improvements following this kind of therapy in terms of recovery of organ function.
在严重脓毒症和感染性休克的发病机制中，涉及的关键分子之一是脂多糖（LPS）或内毒素，它是革兰氏阴性菌细胞壁的组成部分。临床研究表明，循环 LPS 水平与疾病严重程度（APACHE II）、器官功能障碍的发生和程度（SOFA）以及重症监护病房死亡率相关。许多治疗策略试图中和内毒素的致病活性，以阻止脓毒症状态向更严重的临床框架（即严重脓毒症和感染性休克）发展。在过去的几十年中，通过多粘菌素 B 为基础的吸附柱（PMX-DHP）进行体外血液灌流以结合和中和全血中的 LPS 的作用在临床相关性方面有所增加。这是由于越来越多的研究证实，对内毒素休克的靶向治疗可以显著影响脓毒症级联的进程。这篇综述将概述对内毒素的靶向治疗的意义，既强调了多粘菌素 B 对内毒素清除的特异性免疫效应，也强调了这种治疗在器官功能恢复方面改善临床效果的证据。
