Śmiechowicz Jakub
Department of Anaesthesiology and Intensive Therapy, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland.
J Clin Med. 2022 Jan 26;11(3):619. doi: 10.3390/jcm11030619.
Lipopolysaccharide, the main component of the outer membrane of Gram-negative bacteria is a highly potent endotoxin responsible for organ dysfunction in sepsis. It is present in the blood stream not only in Gram-negative infections, but also in Gram-positive and fungal infections, presumably due to sepsis-related disruption of the intestinal barrier. Various pathways, both extra- and intracellular, are involved in sensing endotoxin and non-canonical activation of caspase-mediated pyroptosis is considered to have a major role in sepsis pathophysiology. Endotoxin induces specific pathological alterations in several organs, which contributes to poor outcomes. The adverse consequences of endotoxin in the circulation support the use of anti-endotoxin therapies, yet more than 30 years of experience with endotoxin adsorption therapies have not provided clear evidence in favor of this treatment modality. The results of small studies support timely endotoxin removal guided by measuring the levels of endotoxin; unfortunately, this has not been proven in large, randomized studies. The presence of endotoxemia can be demonstrated in the majority of patients with COVID-19, yet only case reports and case series describing the effects of endotoxin removal in these patients have been published to date. The place of blood purification therapies in the treatment of septic shock has not yet been determined.
脂多糖是革兰氏阴性菌外膜的主要成分，是一种强效内毒素，可导致脓毒症中的器官功能障碍。它不仅存在于革兰氏阴性菌感染的血流中，也存在于革兰氏阳性菌和真菌感染中，可能是由于脓毒症相关的肠道屏障破坏所致。多种细胞外和细胞内途径参与内毒素感知，半胱天冬酶介导的细胞焦亡的非经典激活被认为在脓毒症病理生理学中起主要作用。内毒素在多个器官中诱导特定的病理改变，这导致了不良后果。循环中内毒素的不良后果支持使用抗内毒素疗法，然而30多年的内毒素吸附疗法经验并未提供支持这种治疗方式的明确证据。小型研究的结果支持通过测量内毒素水平来指导及时清除内毒素；不幸的是，这在大型随机研究中尚未得到证实。大多数新冠肺炎患者都可检测到内毒素血症，但迄今为止，仅发表了描述内毒素清除对这些患者影响的病例报告和病例系列。血液净化疗法在感染性休克治疗中的地位尚未确定。
