Nys M, Damas P, Joassin L, Lamy M
Department of Anesthesiology, University Hospital of Liège, Belgium.
Ann Surg. 1993 Mar;217(3):300-6. doi: 10.1097/00000658-199303000-00013.
This study follows the sequential changes in anti-lipopolysaccharide antibodies in infected patients with and without septic shock.
A relation between high endogenous levels of anti-LPS antibodies and protection against bacteremia and septic shock in at-risk patient groups has been observed. However, information on the daily follow-up and kinetics of apparition or disappearance of anti-LPS antibody activities and their relations with the protective properties of the different immunoglobulin classes has not been clearly investigated.
Two hundred and five septic surgical patients were studied during their stay in the intensive care unit during a period of 3 years. Among these patients, septic shock developed in 54 and 47 died. A sensitive ELISA was used to study circulating IgM and IgG antibodies to the core glycolipid (CGL) region of Salmonella minnesota R595. The activities were measured each day when sepsis occurred and every hour during septic shock.
Anti-CGL IgM activity was found in 32% of the septic patients. This response, however, most often appeared to be transient. A strong correlation was observed between the occurrence of septic shock and the absence of anti-CGL IgM activity on admission to the ICU (p < 0.02). Anti-CGL IgG activity was detected in 82% of the patients and better correlated with outcome for patients with high or rising activities during their hospitalization (p < 0.0005). In patients with septic shock or irreversible organ failure, a fall in the anti-CGL IgG activity was observed before death, suggesting that the IgG antibodies were consumed during this acute event. Therefore, the anti-CGL IgG activity measured by ELISA could be used as a marker of the evolution of the illness.
Our observations demonstrate the interest to follow-up the evolution of the anti-CGL antibodies during sepsis. The fall of these antibodies during septic shock and in patients who died was an additional argument to perform, as an additive form, passive antibody therapy to decrease lethality in this group of patients.
本研究追踪感染患者（无论有无感染性休克）体内抗脂多糖抗体的动态变化。
在高危患者群体中，已观察到内源性抗脂多糖抗体水平升高与预防菌血症及感染性休克之间存在关联。然而，关于抗脂多糖抗体活性出现或消失的每日随访情况及动力学，以及它们与不同免疫球蛋白类别的保护特性之间的关系，尚未得到明确研究。
对205例接受外科手术的脓毒症患者在重症监护病房住院期间进行了为期3年的研究。这些患者中，54例发生感染性休克，47例死亡。采用灵敏的酶联免疫吸附测定法（ELISA）研究循环中针对明尼苏达沙门氏菌R595核心糖脂（CGL）区域的IgM和IgG抗体。在脓毒症发生当天及感染性休克期间每小时测量抗体活性。
32%的脓毒症患者检测到抗CGL IgM活性。然而，这种反应大多表现为一过性。在入住重症监护病房时，感染性休克的发生与抗CGL IgM活性缺失之间存在强烈相关性（p < 0.02）。82%的患者检测到抗CGL IgG活性，且对于住院期间活性高或升高的患者，其与预后的相关性更好（p < 0.0005）。在发生感染性休克或出现不可逆器官衰竭的患者中，死亡前观察到抗CGL IgG活性下降，提示在这一急性事件中IgG抗体被消耗。因此，通过ELISA测定的抗CGL IgG活性可作为疾病进展的标志物。
我们的观察结果表明，在脓毒症期间追踪抗CGL抗体的变化具有重要意义。在感染性休克期间及死亡患者中这些抗体的下降，是作为一种补充形式进行被动抗体治疗以降低该组患者死亡率的又一论据。
