Bone R C
Department of Internal Medicine, Rush-Presbyterian-St. Luke's Medical Center, Chicago, Illinois 60612.
Clin Microbiol Rev. 1993 Jan;6(1):57-68. doi: 10.1128/CMR.6.1.57.
Gram-negative sepsis is an increasingly common problem, with up to 300,000 cases occurring each year in the United States alone. Despite the ongoing development of new antibiotics, mortality from gram-negative sepsis remains unacceptably high. To stimulate earlier therapeutic intervention by physicians, a new set of broad definitions has been proposed to define the systemic inflammatory response characteristic of sepsis. In this review, the signs and symptoms of this progressive, injurious process are reviewed and its management is discussed, as are the mechanisms by which bacterial endotoxin triggers the biochemical events that lead to such serious complications as shock, adult respiratory distress syndrome, and disseminated intravascular coagulation. These events often occur even when appropriate antimicrobial therapy has been instituted. An increased understanding of the structure of endotoxin and its role in the development of sepsis, together with advances in hybridoma technology, has led to the development of monoclonal antibodies that bind to endotoxin and significantly attenuate its adverse effects. These agents promise to substantially reduce the morbidity and mortality associated with gram-negative sepsis.
革兰氏阴性菌败血症是一个日益常见的问题，仅在美国每年就有多达30万例病例发生。尽管新型抗生素不断研发，但革兰氏阴性菌败血症导致的死亡率仍然高得令人难以接受。为了促使医生更早地进行治疗干预，已提出了一套新的宽泛定义来界定败血症所特有的全身炎症反应。在本综述中，将对这一渐进性、损伤性过程的体征和症状进行回顾，并讨论其治疗方法，同时还将探讨细菌内毒素触发导致休克、成人呼吸窘迫综合征和弥散性血管内凝血等严重并发症的生化事件的机制。即使已经采取了适当的抗菌治疗，这些事件仍常常发生。对内毒素结构及其在败血症发展中的作用的进一步了解，再加上杂交瘤技术的进步，已促成了与内毒素结合并能显著减轻其不良反应的单克隆抗体的研发。这些药物有望大幅降低与革兰氏阴性菌败血症相关的发病率和死亡率。
