Mustafa M M, Mertsola J, Ramilo O, Sáez-Llorens X, Risser R C, McCracken G H
Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas 75235-9063.
J Infect Dis. 1989 Nov;160(5):891-5. doi: 10.1093/infdis/160.5.891.
Intraventricular gentamicin therapy in infants with gram-negative enteric bacillary meningitis and ventriculitis is associated with increased mortality. Therefore, endotoxin, interleukin-1 beta, and cachectin (tumor necrosis factor) concentrations in ventricular cerebrospinal fluid from 21 infants (11 received intravenous antibiotics alone and 10 received intraventricular gentamicin also) were determined and correlated with outcome and other ventricular cerebrospinal fluid indexes of inflammation. Mean interleukin-1 beta concentrations in ventricular cerebrospinal fluid correlated significantly with adverse outcome and with mean concentrations of endotoxin, white blood cells, and protein and inversely with glucose concentrations. Mean and peak endotoxin and interleukin-1 beta concentrations were significantly higher in infants who received intraventricular gentamicin and intravenous antibiotics than in infants given intravenous antibiotics alone. Intraventricular gentamicin may have caused release of endotoxin from gram-negative bacilli in ventricular cerebrospinal fluid, resulting in increased interleukin-1 beta concentrations and inflammation, which could have contributed to the poor outcome in these patients.
对于患有革兰氏阴性肠道杆菌性脑膜炎和脑室炎的婴儿，脑室内注射庆大霉素治疗与死亡率增加相关。因此，测定了21例婴儿（11例仅接受静脉抗生素治疗，10例同时接受脑室内庆大霉素治疗）脑室脑脊液中的内毒素、白细胞介素-1β和恶病质素（肿瘤坏死因子）浓度，并将其与预后及其他脑室脑脊液炎症指标进行关联分析。脑室脑脊液中白细胞介素-1β的平均浓度与不良预后、内毒素、白细胞和蛋白质的平均浓度显著相关，与葡萄糖浓度呈负相关。接受脑室内庆大霉素和静脉抗生素治疗的婴儿，其平均和峰值内毒素及白细胞介素-1β浓度显著高于仅接受静脉抗生素治疗的婴儿。脑室内庆大霉素可能导致脑室脑脊液中革兰氏阴性杆菌释放内毒素，从而导致白细胞介素-1β浓度升高和炎症反应增加，这可能是这些患者预后不良的原因。
