Otero A J, Linares M
Instituto de Medicina Tropical Pedro Kourí.
Rev Cubana Med Trop. 1998;50(1):31-5.
In spite of the advances attained in the diagnosis and early intervention with antibiotics, morbidity and mortality associated with sepsis caused by Gram-negative bacteria are high. The mediators responsible for the pathogenesis of the sepsis are components derived from the own bacteria (endotoxins) and from the cells of the immune response of the host (tumor necrosis factor and some interleukins). The treatment traditionally used in sepsis is mainly directed against microorganisms by the use of increasingly potent antibiotics. However, it is clear that antibiotics are not a definitive solution, since even when they cause bacterial death, they have no effects on endotoxin and may increase their liberation when cellular lysis occurs. New and successful treatments for sepsis have been tried since the 1980's, including the use of polyclonal and monoclonal antibodies of murine and human origin, directed against the lipid A of the endotoxin, as well as monoclonal antibodies against the tumor necrosis factor. Although these molecules are not completely efficient for the interruption of the chain of undesirable events provoked by the endotoxin, it is valid to accept the appearance of immunotherapies as an adjuvant treatment for a condition that threatens life.
尽管在革兰氏阴性菌引起的败血症诊断和早期抗生素干预方面取得了进展，但与之相关的发病率和死亡率仍然很高。导致败血症发病机制的介质是来自细菌本身的成分（内毒素）以及宿主免疫反应细胞（肿瘤坏死因子和一些白细胞介素）。传统上用于败血症的治疗主要是通过使用越来越强效的抗生素来对抗微生物。然而，很明显抗生素并非最终解决方案，因为即使它们能导致细菌死亡，但对内毒素没有作用，并且当细胞裂解发生时可能会增加内毒素的释放。自20世纪80年代以来，人们尝试了新的、成功的败血症治疗方法，包括使用鼠源和人源的多克隆和单克隆抗体，这些抗体针对内毒素的脂质A，以及针对肿瘤坏死因子的单克隆抗体。尽管这些分子对于中断由内毒素引发的不良事件链并不完全有效，但将免疫疗法作为一种威胁生命疾病的辅助治疗方法出现是合理的。
