不同抗生素在G^-细菌感染中诱导内毒素释放的研究

A Study of Endotoxin Release Induced by Different Antibiotics in Gram Negative Bacterial Infection

目的 研究不同抗生素在治疗G-细菌感染中诱导内毒素释放的情况及对全身炎症反应的影响。方法 将ICU内 30例G-细菌感染患者随机均分为两组 ,分别接受亚胺培南 (A组 )和头孢他啶 (B组 )治疗 ,于用药前和用药后 1、2、3、5及 7天上午 10点进行WBC、收缩压 (SBP)、内毒素 (LPS)、肿瘤坏死因子α(TNFα)及高密度脂蛋白 (HDL)测定。结果 两组患者的WBC变化无明显差异 ;在循环系统稳定上 ,A组优于B组 ;A组在诱导内毒素释放及刺激炎性介质释放的作用明显低于B组 ;B组HDL水平明显低于A组。结论 亚胺培南在治疗G-细菌感染中诱导内毒素释放的作用较头孢他啶弱 ,因而其刺激炎性介质释放的作用也弱于头孢他啶。

Objective To study endotoxin release induced by differential antibiotics in gram negative bacterial infection. Methods Thirty critical patients accompanied with gram negative bacterial infection were divided into group A (imipenem group, n =15) and group B (ceftazidine group, n =15). Imipenem (0.5 g iv q8h) and ceftazidine (1.0 g iv q8h) were given respectively. White blood cell (WBC), systolic blood pressure (SBP), lipopoly sacchride (LPS), tumor necrosis factor alpha (TNFα) and high density lipoprotein (HDL) were determined in 0, 1, 2, 3, 5 and 7 day. Results There was no difference in the change of WBC between two groups. Group A had a more stable SBP than group B. There was lower endotoxin release in group A than in group B and so were the cytokines release. HDL level was lower in group B than in group A. Conclusion Imipenem has lower endotoxin liberating potential than ceftazidine and mediate lower cytokines release. HDL may protect the patients from LPS damage.