Corriveau C C, Danner R L
Critical Care Department, Children's National Medical Center, Washington, D.C.
Infect Agents Dis. 1993 Feb;2(1):44-52.
Gram-negative shock is thought to result primarily from the effects of endotoxin, a component of the bacterial outer membrane. Accordingly, therapies aimed at inhibiting, neutralizing, or clearing endotoxin have been extensively explored. Despite over 30 years of research, no antiendotoxin approach to the treatment of human septic shock is of proven benefit. In recent randomized clinical trials of monoclonal antibodies against endotoxin, therapeutic efficacy was not convincingly demonstrated. This result, however, does not eliminate the possibility that other antiendotoxin therapies may be effective. The antibodies used in these clinical trials do not appear to neutralize endotoxin in vitro and are not reproducibly protective in animal models of sepsis. Newer agents with well-defined mechanisms of antiendotoxin activity may help clarify the role of endotoxin in septic shock and prove useful therapy for some patients.
革兰氏阴性菌感染性休克被认为主要是由内毒素（细菌外膜的一种成分）的作用导致的。因此，人们广泛探索了旨在抑制、中和或清除内毒素的治疗方法。尽管经过了30多年的研究，但尚无一种抗内毒素方法被证明对治疗人类感染性休克有益。在最近针对抗内毒素单克隆抗体的随机临床试验中，治疗效果并未得到令人信服的证明。然而，这一结果并未排除其他抗内毒素疗法可能有效的可能性。这些临床试验中使用的抗体在体外似乎无法中和内毒素，并且在脓毒症动物模型中也无法持续发挥保护作用。具有明确抗内毒素活性机制的新型药物可能有助于阐明内毒素在感染性休克中的作用，并为一些患者提供有效的治疗方法。
