• 四川大學(xué)華西醫(yī)院加強(qiáng)醫(yī)療科(成都610041);

目的  研究不同抗生素在治療G-細(xì)菌感染中誘導(dǎo)內(nèi)毒素釋放的情況及對(duì)全身炎癥反應(yīng)的影響。
方法  將ICU內(nèi)30例G-細(xì)菌感染患者隨機(jī)均分為兩組，分別接受亞胺培南(A組)和頭孢他啶(B組)治療，于用藥前和用藥后1、2、3、5及7天上午10點(diǎn)進(jìn)行WBC、收縮壓(SBP)、內(nèi)毒素（LPS）、腫瘤壞死因子α（TNFα）及高密度脂蛋白（HDL）測(cè)定。
結(jié)果  兩組患者的WBC變化無明顯差異； 在循環(huán)系統(tǒng)穩(wěn)定上，A組優(yōu)于B組； A組在誘導(dǎo)內(nèi)毒素釋放及刺激炎性介質(zhì)釋放的作用明顯低于B組； B組HDL水平明顯低于A組。
結(jié)論  亞胺培南在治療G-細(xì)菌感染中誘導(dǎo)內(nèi)毒素釋放的作用較頭孢他啶弱，因而其刺激炎性介質(zhì)釋放的作用也弱于頭孢他啶。HDL在保護(hù)機(jī)體對(duì)抗LPS的損害中可能有一定的作用。

引用本文： 康焰,金曉東,吳淑紅,程青鴻. 不同抗生素在G-細(xì)菌感染中誘導(dǎo)內(nèi)毒素釋放的研究. 中國(guó)普外基礎(chǔ)與臨床雜志, 2002, 9(1): 13-15. doi: 復(fù)制

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6. Jackson JJ,Kropp H.BetaLactam antibioticinduced release of free endotoxin: in vitro comparison of penicillinbinding protein(PBP)2specific imipenem and PBP3specific ceftazidine [Ｊ]. J Infect Dis,1992； 165(6)∶ 1033.
7. Bryan CS, Harrison RV.Appropriate initial antimicrobial therapy of severe sepsis [Ｊ]. Infect Med,1994； 11(3)∶ 372.
8. Ulevitch RJ, Johnston AR, Weinstein DB. New function for high density lipoproteins. Their participation in intravascular reactions of bacterial lipopolysaccharides [Ｊ]. J Clin Invest,1979； 64(5)∶ 1516.
9. Harris HW, Grunfeld C, Feingold KR, et al. Human very low density lipoproteins and chylomicrons can protect against endotoxininduced death in mice [Ｊ]. J Clin Invest,1990； 86(3)∶ 696.
  1. 1. Hopkin DA. Too rapid destruction of gramnegative organisms [Ｊ]. Lancet,1977； 17(8038)∶ 603.
  2. 2. Horn DL, Opal SM, Lomastro E. Antibiotics, cytokines, and endotoxin: a complex and evolving relationship in gramnegative sepsis [Ｊ]. Scand J Infect Dis Suppl,1996； 101(1)∶ 9.
  3. 3. 周向東，陽(yáng)濤.抗生素殺菌過程致內(nèi)毒素釋放的比較研究 [Ｊ].中華內(nèi)科雜志,1998； 37(10)∶ 686.
  4. 4. Norimatsu M, Morrison DC. Correlation of antibioticinduced endotoxin release and cytokine production in Escherichia coliinoculated mouse whole blood ex vivo [Ｊ]. J Infect Dis,1998； 177(5)∶ 1302.
  5. 5. Bucklin SE, Morrison DC. Differences in therapeutic efficacy among cell wallactive antibiotics in a mouse model of gramnegative sepsis [Ｊ]. J Infect Dis,1995； 172(6)∶ 1519.
  6. 6. Jackson JJ,Kropp H.BetaLactam antibioticinduced release of free endotoxin: in vitro comparison of penicillinbinding protein(PBP)2specific imipenem and PBP3specific ceftazidine [Ｊ]. J Infect Dis,1992； 165(6)∶ 1033.
  7. 7. Bryan CS, Harrison RV.Appropriate initial antimicrobial therapy of severe sepsis [Ｊ]. Infect Med,1994； 11(3)∶ 372.
  8. 8. Ulevitch RJ, Johnston AR, Weinstein DB. New function for high density lipoproteins. Their participation in intravascular reactions of bacterial lipopolysaccharides [Ｊ]. J Clin Invest,1979； 64(5)∶ 1516.
  9. 9. Harris HW, Grunfeld C, Feingold KR, et al. Human very low density lipoproteins and chylomicrons can protect against endotoxininduced death in mice [Ｊ]. J Clin Invest,1990； 86(3)∶ 696.