Scheifele D W, Olsen E, Fussell S, Pendray M
J Pediatr Gastroenterol Nutr. 1985 Feb;4(1):67-74. doi: 10.1097/00005176-198502000-00013.
Infants admitted to a tertiary care nursery were tested serially to determine the frequency and epidemiology of spontaneous endotoxinemia, a phenomenon suggested by previous studies. Plasma and stools were tested for endotoxin-like activity (ELA) using a Limulus amoebocyte lysate method and results were correlated with clinical data. We detected ELA in plasma of 28 of 47 infants (60%) tested throughout their hospital stay: only two of 58 separate episodes could be attributed to infection. Endotoxinemia was not consistently associated with classical signs of fever, shock, and jaundice. Prior to oral feeding, little or no ELA was detected in stools and endotoxinemia was ascertained in only six of 45 infants (13%). With feeding, fecal ELA concentrations rose sharply, and endotoxinemia was detected in 56% of remaining infants (p less than 0.001). Bowel disease predisposed to endotoxinemia: 16 of 20 infants (80%) with necrotizing entercolitis or difficult establishment on feeding were affected, compared to five of 17 infants (29%) without such problems (p less than 0.01). Fecal ELA concentrations were not abnormally elevated in those with bowel disease. We conclude that endotoxinemia occurs commonly in immature infants as their fecal flora develops with feeding but the amount of circulating endotoxin required for injury and the patterns this takes require further investigation.
入住三级护理新生儿病房的婴儿接受了一系列检测，以确定自发性内毒素血症的发生频率和流行病学特征，此前的研究提示了这一现象。采用鲎试剂法检测血浆和粪便中的内毒素样活性（ELA），并将结果与临床数据相关联。在整个住院期间接受检测的47名婴儿中，我们在28名婴儿（60%）的血浆中检测到了ELA：在58次单独发作中，只有2次可归因于感染。内毒素血症与发热、休克和黄疸等典型体征并无始终如一的关联。在经口喂养前，粪便中很少或未检测到ELA，45名婴儿中只有6名（13%）确诊为内毒素血症。随着喂养，粪便ELA浓度急剧上升，其余婴儿中有56%检测到内毒素血症（p<0.001）。肠道疾病易引发内毒素血症：20名患有坏死性小肠结肠炎或喂养困难的婴儿中有16名（80%）受到影响，而17名无此类问题的婴儿中有5名（29%）受到影响（p<0.01）。患有肠道疾病的婴儿粪便ELA浓度并未异常升高。我们得出结论，随着喂养后粪便菌群的发展，内毒素血症在未成熟婴儿中普遍存在，但造成损伤所需的循环内毒素量及其表现形式仍需进一步研究。
