Clemente C, Bosch J, Rodés J, Arroyo V, Mas A, Maragall S
Gut. 1977 Jul;18(7):556-60. doi: 10.1136/gut.18.7.556.
Forty-three patients with cirrhosis and ascites, 21 with normal renal function, 10 with a progressive functional renal failure (FRF), and 12 with a steady FRF, were investigated for the presence of endotoxaemia by the Limulus lysate test. Endotoxaemia was found in nine patients with FRF and in none of the 21 with normal renal function (P less than 0-01). A positive Limulus test was almost exclusively associated with a progressive FRF (eight of 10 patients) and all but one of them died. Renal function improved as endotoxaemia disappeared in the survivor. Endotoxaemia was also associated with haemorrhage due to acute erosions of the gastric mucosa, being present in six of the seven patients who had this complication. Intravascular coagulation was not found in any patient. The Limulus test was positive in the ascitic fluid in 18 of 21 patients tested, although only two of them had peritonitis. These results suggest that endotoxaemia may play a critical role in the development of progressive renal failure and haemorrhagic gastritis in cirrhosis, and emphasise the potential risk of procedures involving reinfusion of ascitic fluid.
对43例肝硬化腹水患者进行了研究，其中21例肾功能正常，10例为进行性功能性肾衰竭（FRF），12例为稳定型FRF，采用鲎试剂检测法检测内毒素血症的存在情况。在10例FRF患者中发现了内毒素血症，而21例肾功能正常的患者中均未发现（P<0.01）。鲎试剂检测阳性几乎仅与进行性FRF相关（10例患者中有8例），除1例患者外，其余患者均死亡。幸存者体内内毒素血症消失后，肾功能有所改善。内毒素血症还与胃黏膜急性糜烂引起的出血有关，7例有此并发症的患者中有6例存在内毒素血症。所有患者均未发现血管内凝血。在21例接受检测的患者中，有18例腹水的鲎试剂检测呈阳性，尽管其中只有2例患有腹膜炎。这些结果表明，内毒素血症可能在肝硬化患者进行性肾衰竭和出血性胃炎的发生中起关键作用，并强调了涉及腹水回输的操作存在潜在风险。
