微生态制剂改善非酒精性脂肪性肝病患者胰岛素抵抗的临床研究

目的:观察美常安对非酒精性脂肪性肝病(NAFLD)患者临床症状及胰岛素抵抗(IR)的作用。方法:选取2009年4月至2013年3月我院收治的88例NAFLD患者,随机分为治疗组和对照组。对照组给予基础治疗,治疗组在对照组的基础上,加用美常安胶囊进行治疗。比较两组疗效及治疗前后两组血清谷丙转氨酶(ALT)、甘油三酯(TG)及稳态胰岛素抵抗指数(HOMA-IR)水平,并分析血浆D乳酸、TNF-α、内毒素与HOMA-IR的相关性,观察两组不良反应情况。结果:治疗组治疗有效率为52.3%,明显高于对照组的29.5%(P0.05)。治疗后治疗组ALT、TG、HOMA-IR下降幅度,均明显优于对照组(P0.05)。治疗后治疗组患者血浆D乳酸、TNF-α、内毒素水平明显低于对照组(P0.05),且治疗组患者HOMA-IR与患者血浆D乳酸、血清TNF-α、内毒素水平呈正相关(r=0.352,0.44,0.48;均P0.05)。不良反应发生率低,且两组不良反应发生率无显著差异(P0.05)。结论:美常安治疗NAFLD疗效显著,可降低ALT、TG水平,降低肠道通透性,改善肠源性内毒素血症,改善IR,且安全性较高。     

连续肾脏替代治疗对脓毒症患者血清中TNF-alpha、IL-6 和IL-8 表达的影响

目的：探讨连续肾脏替代治疗（CRRT）对脓毒症患者血清中肿瘤坏死因子alpha（TNF-alpha）、白介素-6（IL-6）和白介素-8（IL-8）的 影响。方法：将我院2013 年1 月-2014 年6 月间收治的80 例脓毒症患者随机分为观察组与对照组各40 例,两组患者均给予脓毒 症常规治疗,观察组另给予CRRT 治疗。观察比较两组患者治疗前1 天,治疗后24 h,72 h空腹静脉血TNF-alpha、IL-6、IL-8 水平。结 果：观察组治愈率为85.0%（34/40）,明显高于对照组的55.0%（22/40）,差异有统计学意义（P<0.05）;治疗24h、72h 后两组患者 TNF-alpha、IL-6和IL-8 水平均明显下降,其中观察组下降更显著,差异均有统计学意义（P<0.05）。结论：CRRT 能有效降低脓毒症患 者血清中TNF-alpha、IL-6 和IL-8 水平,有助于对炎症反应的正向调节。     

Effect of hyperglycemia and hyperinsulinemia on the response of IL-6, TNF-alpha, and FFAs to low-dose endotoxemia in humans

Insulin therapy to maintain euglycemia increases survival in critically ill patients. To explore possible mechanisms of action, we investigated the effect of endotoxin on circulating cytokines, free fatty acids (FFA), and leukocytes during manipulated plasma glucose and insulin concentrations. Ten volunteers underwent three trials each, receiving an intravenous bolus of endotoxin (0.2 ng/kg) during normoglycemia (trial A, control), during a hyperglycemic clamp at 15 mM (trial B), and during a hyperinsulinemic euglycemic clamp (trial C). Endotoxin induced an increase in neutrophil count, a decrease in lymphocyte count, and an increase in serum levels of TNF-alpha, IL-6, and FFA. There was no difference in the TNF response between the three trials; the IL-6 levels were increased during the late phase of trials B and C compared with trial A. The endotoxin-induced elevation in FFA in trial A was suppressed during trials B and C. Clamping (trials B and C) caused a reduction in lymphocyte count that persisted after endotoxin injection. We conclude that low-dose endotoxemia triggers a subclinical inflammatory response and an elevation in FFA. The finding that high insulin serum concentrations induce a more prolonged increase in the anti-inflammatory cytokine IL-6 and suppress the levels of FFA suggests that insulin treatment of patients with sepsis may exert beneficial effects by inducing anti-inflammation and protection against FFA toxicity, and thereby inhibit FFA-induced insulin resistance.     

Involvement of endotoxin in the mortality of mice with gut‐derived sepsis due to methicillin‐resistant Staphylococcus aureus

MRSA causes a wide diversity of diseases, ranging from benign skin infections to life‐threatening diseases, such as sepsis. However, there have been few reports of the pathophysiology and mechanisms of sepsis resulting from the gut‐derived origin of MRSA. Therefore, we established a murine model of gut‐derived sepsis with MRSA and factors of MRSA sepsis that cause deterioration. We separated mice into four groups according to antibiotic treatment as follows: (i) ABPC 40 mg/kg; (ii) CAZ 80 mg/kg; (iii) CAZ 80 mg/kg + endotoxin 10 μg/mouse; and (iv) saline‐treated control groups. Gut‐derived sepsis was induced by i.p. injection of cyclophosphamide after colonization of MRSA strain 334 in the intestine. After the induction of sepsis, significantly more CAZ‐treated mice survived compared with ABPC‐treated and control groups. MRSA were detected in the blood and liver among all groups. Endotoxin levels were significantly lower in the CAZ‐treated group compared to other groups. Inflammatory cytokine levels in the serum were lower in the CAZ‐treated group compared to other groups. Fecal culture showed a lower level of colonization of E. coli in the CAZ‐treated group compared to other groups. In conclusion, we found that CAZ‐treatment ameliorates infection and suppresses endotoxin level by the elimination of E. coli from the intestinal tract of mice. However, giving endotoxin in the CAZ‐treated group increased mortality to almost the same level as in the ABPC‐treated group. These results suggest endotoxin released from resident E. coli in the intestine is involved in clinical deterioration resulting from gut‐derived MRSA sepsis.     

Endotoxin downregulates peroxisome proliferator-activated receptor-gamma via the increase in TNF-alpha release

The nuclear receptor peroxisome proliferator-activated receptor-gamma (PPAR-gamma) is anti-inflammatory in a cell-based system and in animal models of endotoxemia. We have shown that PPAR-gamma gene expression is downregulated in macrophages after lipopolysaccharide (LPS) stimulation. However, it remains unknown whether hepatic PPAR-gamma is altered in sepsis and, if so, whether LPS directly downregulates PPAR-gamma. To study this, rats were subjected to sepsis by cecal ligation and puncture (CLP). Hepatic tissues were harvested at 5, 10, and 20 h after CLP. PPAR-gamma gene expression and protein levels were determined by RT-PCR and Western blot analysis, respectively. The results showed that PPAR-gamma gene expression decreased at 10 and 20 h and that its proteins levels were reduced at 20 h after CLP. PPAR-gamma levels were also decreased in animals that were administered LPS. To determine the direct effects of LPS on PPAR-gamma downregulation, LPS binding agent polymyxin B (PMB) was administered intramuscularly after CLP. The administration of PMB significantly reduced plasma levels of endotoxin, but it did not prevent the downregulation of PPAR-gamma expression. We found that circulating levels of TNF-alpha still remained significantly elevated in PMB-treated septic animals. We, therefore, hypothesize that the decrease of PPAR-gamma expression is TNF-alpha dependent. To investigate this, Kupffer cells (KCs) were isolated from normal rats and stimulated with LPS or TNF-alpha. TNF-alpha significantly attenuated PPAR-gamma gene expression in KCs. Although LPS decreased PPAR-gamma in KCs, the downregulatory effect of LPS was blocked by the addition of TNF-alpha-neutralizing antibodies. Furthermore, the administration of TNF-alpha-neutralizing antibodies to animals before the onset of sepsis prevented the downregulation of PPAR-gamma in sepsis. We, therefore, conclude that LPS downregulates PPAR-gamma expression during sepsis via an increase in TNF-alpha release.     

Effects of pexiganan alone and combined with betalactams in experimental endotoxic shock

To investigate the efficacy of pexiganan, a 22-residue magainin analog, alone and combined with betalactmas antibiotics in three experimental rat models of Gram-negative septic shock. Adult male Wistar rats were given (i) an intraperitoneal injection of 1 mg Escherichia coli 0111:B4 LPS; (ii) 2x10(10)CFU of E. coli ATCC 25922; and (iii) intra-abdominal sepsis induced via cecal ligation and puncture. For each model, all animals were randomized to receive intraperitoneally isotonic sodium chloride solution, 1 mg/kg pexiganan, 1 mg/kg polymyxin B, 20 mg/kg imipenem, 60 mg/kg piperacillin alone and combined with 1 mg/kg pexiganan. Each group included 15 animals. Lethality, bacterial growth in blood or intra-abdominal fluid, endotoxin and TNF-alpha concentrations in plasma. All compounds reduced the lethality when compared to controls. Piperacillin and imipenem significantly reduced the lethality and the number of E. coli in abdominal fluid compared with saline treatment. Pexiganan showed a slightly lower antimicrobial activity than betalactams even though it achieved a substantial higher decrease in endotoxin and TNF-alpha plasma concentrations than imipenem and piperacillin. No statistically significant differences were noted for antimicrobial and antiendotoxin activities between pexiganan and polymyxin B. Combination between pexiganan and betalactams showed to be the most effective treatment in reducing all variables measured. The use of a novel antimicrobial compound able to bind to LPS associated to potent antibiotics such as betalactams may become an important future consideration for sepsis treatment.     

The role of Kupffer cell alpha(2)-adrenoceptors in norepinephrine-induced TNF-alpha production

Although previous studies have demonstrated that plasma levels of the proinflammatory cytokine tumor necrosis factor-alpha (TNF-alpha) increase during early sepsis, the precise mechanism responsible for its upregulation remains to be elucidated. Since recent studies have shown that the gut is an important source of norepinephrine (NE) release during early sepsis and enterectomy prior to the onset of sepsis attenuates TNF-alpha production, we hypothesized that gut-derived NE plays a major role in upregulating TNF-alpha via the activation of alpha(2)-adrenoceptors on Kupffer cells. To confirm that NE increases TNF-alpha synthesis and release, Kupffer cells were isolated from normal rats and incubated with NE (20 or 50 nM) or another alpha(2)-adrenergic agonist clonidine (50 nM) without addition of Escherichia coli endotoxin. Supernatant levels of TNF-alpha were then measured. In additional animals, intraportal infusion of NE (20 microM) with or without the specific alpha(2)-adrenergic antagonist yohimbine (1 mM) at a rate of 13 microl/min was carried out for 2 h. Plasma and Kupffer cell levels of TNF-alpha were assayed thereafter. Moreover, the effects of NE and yohimbine on TNF-alpha production was further examined using an isolated perfused liver preparation. The results indicate that both NE and clonidine increased TNF-alpha release by approximately 4-7-fold in the isolated cultured Kupffer cells. Similarly, intraportal infusion of NE in vivo or in isolated livers increased TNF-alpha synthesis and release which was inhibited by co-infusion of yohimbine. Furthermore, the increased cellular levels of TNF-alpha in Kupffer cells after in vivo administration of NE was also blocked by yohimbine. These results, taken together, suggest that gut-derived NE upregulates TNF-alpha production in Kupffer cells through an alpha(2)-adrenergic pathway, which appears to be responsible at least in part for the increased levels of circulating TNF-alpha observed during early sepsis as well as other pathophysiologic conditions such as trauma, hemorrhagic shock, or gut ischemia/reperfusion.     

IFN-gamma is not induced through increased plasma concentrations of interleukin-12/interleukin-18 during human endotoxemia

Endotoxin administration to animals and humans is an accepted experimental model of Gram-negative sepsis, and endotoxin is believed to play a major role in triggering the activation of cytokines. In septic patients, the IL-12/IL-18/IFN-gamma axis is activated and correlates with mortality. Our aim was to investigate the effects of endotoxin administration in humans on the activation of the IL-12/IL-18/IFN-gamma axis. Seven healthy volunteers received E. coli endotoxin (O:113). Hemodynamics, temperature and the course of plasma concentrations of TNF-alpha, IL-1beta, IL-12, IL-18 and IFN-gamma were determined. Endotoxin administration resulted in the expected flu-like symptoms, a temperature of 38.8 +/- 0.3(o)C (p < 0.003), a decrease in mean arterial blood pressure of 14.8 +/- 1.8 mmHg (p < 0.0002) and an increase in heart rate of 27.5 +/- 4.8 bpm (p < 0.002) compared to baseline values. TNF-alpha increased from 16.6 +/- 8.2 to 927 +/- 187 pg/mL (p < 0.003). IL-1beta increased from 8.6 +/- 0.5 to 25.3 +/- 2.0 pg/mL (p < 0.0001). IL-12 showed no significant increase (8.2 +/- 0.2 to 9.3 +/- 0.8 pg/mL, p = 0.13), and all IL-18 measurements remained below the level of detection. In contrast, IFN-gamma showed an increase from 106.6 +/- 57.1 to 152.7 +/- 57.8 (p < 0.005). These results indicate that pathways other than the IL-12/IL-18 axis may induce IFN-gamma production in human endotoxemia.     

Monoclonal antibodies to endotoxin in the management of sepsis.

New monoclonal antibodies directed against the lipid A moiety of the endotoxin present in gram-negative bacteria have been developed to improve the clinical outcome in patients with sepsis. Two studies of monoclonal antibodies HA-1A and E5 retrospectively identified specific patient subgroups showing benefit with therapy. I analyze and summarize the new sepsis nomenclature, the structure of endotoxin, the data implicating endotoxin as a causative agent in septic patients'' morbidity and mortality, and specific data from the 2 clinical studies of monoclonal antibody therapy.     

调整肠道菌群对肝癌介入治疗后肝功能及内毒素的影响作用研究

目的了解调整肠道菌群在肝癌介入治疗中的作用。方法将56例肝癌患者随机分为2组,治疗组在肝动脉化疗栓塞（TACE）前后常规治疗加服培菲康,对照组TACE前后按常规治疗,2组TACE前后检测转氨酶和内毒素水平。结果治疗组血肝功能水平与术前相比差异有显著性（P〈0.05）,而对照组血肝功能水平比术前明显降低（P〈0.01）;治疗组血内毒素水平与术前相比差异无显著性（P〉0.05）,而对照组血内毒素水平比术前升高（P〈0.05）;治疗组在TACE后血转氨酶和内毒素水平较对照组均降低（P〈0.05）。结论肝癌TACE后应用微生态制剂,可降低血内毒素水平,改善肝功能状态,对于减少并发症,促进机体的恢复有重要意义。     

Effect of short-term intralipid infusion on the immune response during low-dose endotoxemia in humans

Novel anti-inflammatory effects of insulin have recently been described, and insulin therapy to maintain euglycemia suppresses the plasma levels of free fatty acids (FFA) and increases the survival of critically ill patients. We aimed to explore the effect of short-term high levels of plasma FFA on the inflammatory response to a low dose of endotoxin. Fourteen healthy male volunteers underwent the following two trials in a randomized crossover design: 1) continuous infusion of 20% Intralipid [0.7 ml.kg(-1).h(-1) (1.54 g/kg)] for 11 h, and 2) infusion of isotonic saline for 11 h (control). In each trial, heparin was given to activate lipoprotein lipase, and an intravenous bolus of endotoxin (0.1 ng/kg) was given after 6 h of Intralipid/saline infusion. Blood samples and muscle and fat biopsies were obtained before the Intralipid/saline infusion and before as well as after infusion of an endotoxin bolus. Plasma levels of FFA, triglycerides, and glycerol were markedly increased during the Intralipid infusion. Endotoxin exposure induced an increase in plasma levels of TNF-alpha, IL-6, and neutrophils and further stimulated gene expression of TNF-alpha and IL-6 in both skeletal muscle and adipose tissue. The systemic inflammatory response to endotoxin was significantly pronounced during Intralipid infusion. Short-term hyperlipidemia enhances the inflammatory response to endotoxin, and skeletal muscle and adipose tissue are capable of producing essential inflammatory mediators after endotoxin stimulation.     

培菲康对肝硬化血浆内毒影响的研究

目的　探讨益生菌制剂培菲康治疗肝硬化内毒素血症的作用机制。方法　采用大鼠肝硬化模型,其中治疗组予以培菲康液每天灌胃治疗,共8周,检测治疗组及对照组血浆内毒指标;并选取70例肝硬化Child-Pugh分级为B级的患者,其中治疗组口服培菲康胶囊(每次2粒,每天3次) 3周,观察治疗前后血浆内毒素变化。结果　培菲康治疗组的肝硬化大鼠及患者血浆内毒素均明显低于对照组( P<0 .0 5 )。结论　培菲康能明显降低肝硬化患者血浆内毒素水平,可作为肝硬化患者的辅助用药     

Cholinergic agonists inhibit HMGB1 release and improve survival in experimental sepsis

Physiological anti-inflammatory mechanisms can potentially be exploited for the treatment of inflammatory disorders. Here we report that the neurotransmitter acetylcholine inhibits HMGB1 release from human macrophages by signaling through a nicotinic acetylcholine receptor. Nicotine, a selective cholinergic agonist, is more efficient than acetylcholine and inhibits HMGB1 release induced by either endotoxin or tumor necrosis factor-alpha (TNF-alpha). Nicotinic stimulation prevents activation of the NF-kappaB pathway and inhibits HMGB1 secretion through a specific 'nicotinic anti-inflammatory pathway' that requires the alpha7 nicotinic acetylcholine receptor (alpha7nAChR). In vivo, treatment with nicotine attenuates serum HMGB1 levels and improves survival in experimental models of sepsis, even when treatment is started after the onset of the disease. These results reveal acetylcholine as the first known physiological inhibitor of HMGB1 release from human macrophages and suggest that selective nicotinic agonists for the alpha7nAChR might have therapeutic potential for the treatment of sepsis.     

马齿苋多糖对溃疡性结肠炎小鼠肠道菌群及血内毒素的影响

目的应用马齿苋多糖对溃疡性结肠炎小鼠进行调整治疗,达到从微生态学角度防治溃疡性结肠炎。方法应用DSS制备溃疡性结肠炎小鼠模型,随机分成2组：正常对照组、模型组,造模成功后模型组再分为自然恢复组、马齿苋多糖治疗组。分别于造模后、给药7 d后处死小鼠,进行肠道菌群检测、血内毒素含量测定。结果 DSS造模后模型组小鼠肠道菌群失调,外周血内毒素含量升高。马齿苋多糖治疗7 d后治疗组小鼠肠道双歧杆菌和乳酸杆菌数量明显上升,外周血内毒素含量明显下降。结论马齿苋多糖可以提高双歧杆菌和乳酸杆菌数量,降低外周血内毒素含量,调节肠道微生态失调,对溃疡性结肠炎发挥了一定的治疗作用。     

谷氨酰胺对脓毒症患者肠粘膜屏障功能和免疫功能的影响

目的:研究谷氨酰胺对脓毒症患者肠道黏膜屏障功能和免疫功能的影响。方法:将2012年10月至2013年10本院收治的40例脓毒症患者随机分为治疗组和对照组,每组20例。两组患者均给予常规对症治疗,治疗组在此基础上加用谷氨酰胺治疗,对照组接受安慰剂治疗。采用分光光度法监测其血清D-乳酸水平,高效液相色谱法监测尿乳果糖/甘露醇(L/M)值。对比两组肠道黏膜屏障功能和免疫功能指标及ARDS、MODS发生率。结果:治疗后,治疗组ARDS和MODS发生率分别为24.1%,17.2%,均低于对照组的38.9%,33.3%,两组比较差异均有统计学意义(P0.05);治疗14 d后,治疗组D-乳酸及尿L/M水平较对照组明显降低,血清Ig G、Ig M、CD4+和CD4+/CD8+水平均增高,两组比较差异均有统计学意义(P0.05)。结论:谷氨酰胺治疗脓毒性患能明显改善肠道黏膜屏障功能,促进患者免疫功能和营养状态的提高,同时还能够降低患者肠道细菌、内毒素移位。     

Differential roles of tumor necrosis factor-alpha and interferon-gamma in mouse hypermetabolic and anorectic responses induced by LPS

Lipopolysaccharide (LPS)-induced effects on energy balance are characterized by alterations in energy expenditure (hypermetabolism) and food intake (anorexia). To study the role of tumour necrosis factor alpha (TNF-alpha) on some of these metabolic responses to endotoxin, we have used transgenic mice expressing soluble tumour necrosis factor receptor-1 IgG fusion protein (TNFR1-IgG) as well as TNF-alpha knockout (KO), lymphotoxin-alpha (LT-alpha) KO, and interferon-gamma receptor (IFN-gamma R) KO mice. The results from TNFR1-IgG transgenic mice suggest that the hypermetabolic and anorectic responses induced by LPS are independently regulated since, in the absence of TNF-alpha or LT-alpha, the LPS-induced hypermetabolism is almost prevented but not the anorexia. The anorectic response shows the strongest association with IFN-gamma since both IFN-gamma R KO mice and mice treated with anti-IFN-gamma antibody showed marked reduction in the LPS-induced anorexia compared to other mice. IFN-gamma R KO mice also have an attenuated thermogenic response to endotoxin. Anti-Asialo GM1 antibody treatment attenuated both the hypermetabolic and anorectic responses to LPS, to an extent comparable to that observed in IFN-gamma R KO mice. This finding suggests that natural killer cells (lymphocytic subsets) may be involved in IFN-gamma production and play an important role in the metabolic alterations induced by LPS. We also showed that the hypermetabolic response of control mice is associated with an upregulation of cytokine expression within the brain and an increase in permeability of the blood brain barrier. LPS-induced anorexia appears to involve peripheral cytokine expression.     

血清PCT、CRP及内毒素在细菌性血流感染所致脓毒症患者中的早期诊断价值

目的:探究血清降钙素原(PCT)、C反应蛋白(CRP)及内毒素在革兰阳性(G+)杆菌与革兰阴性(G-)球菌血流感染所致脓毒症患者中的早期诊断价值。方法:回顾性分析2010年5月~2015年5月期间我院收治确诊的细菌性血流感染所致脓毒症患者123例,测定其血清PCT、CRP及内毒素水平,通过受试者工作特征曲线(ROC)曲线探究三者对细菌性血流感染所致脓毒症的评估价值。结果:血样培养结果显示,35例患者感染G+菌,88例患者感染G-菌;G-菌组患者血清PCT、CRP及内毒素水平均显著高于G+菌组(P0.05);且G+菌组、G-菌组及所有细菌组患者血清PCT、CRP、内毒素间均呈正相关关系(P0.05);ROC曲线显示,血清PCT、CRP和内毒素诊断G+菌血流感染所致脓毒症患者的截断值分别为1.58μg/L、95.25 mg/L与16.71ng/L,其灵敏度和特异度别为(65.92%,88.37%)、(67.39%,84.38%)与(56.34%,78.93%),诊断G-菌血流感染所致脓毒症患者的截断值分别为2.45μg/L、79.45 mg/L与15.54 ng/L,其灵敏度和特异度别为(78.73%,97.13%)、(68.89%,92.38%)与(65.39%,95.33%)。结论:检测血清PCT、CRP、内毒素水平有利于鉴别G-菌和G+菌血流感染所致脓毒症患者,且敏感度、特异度均较高,可用于早期诊断细菌性血流感染所致脓毒症。     

Inhibitory effects of Lactobacillus plantarum lipoteichoic acid (LTA) on Staphylococcus aureus LTA-induced tumor necrosis factor-alpha production

Staphylococcus aureus is a common etiologic agent for Gram-positive sepsis, and its lipoteichoic acid (LTA) may be important in causing Gram-positive bacterial septic shock. Here, we demonstrate that highly purified LTA (pLTA) isolated from Lactobacillus plantarum inhibited aureus LTA (aLTA)-induced TNF-alpha production in THP- cells. Whereas pLTA scarcely induced TNF-alpha production, aLTA induced excessive TNF-alpha production. Interestingly, aLTA-induced TNF-alpha production was inhibited by pLTA pretreatment. Compared with pLTA, aLTA induced strong signal transduction through the MyD88, NF-kappaB, and MAP kinases. This signaling, however, was reduced by a pLTA pretreatment, and resulted in the inhibition of aLTA-induced TNF-alpha production. Whereas dealanylated LTAs, as well as native LTAs, contributed to TNF- induction or TNF-alpha reduction, deacylated LTAs did not, indicating that the acyl chain of LTA played an important role in the LTA-mediated immune regulation. These results suggest that pLTA may act as an antagonist for aLTA, and that an antagonistic pLTA may be a useful agent for suppressing the septic shock caused by Gram-positive bacteria.     

Role for MyD88-independent, TRIF pathway in lipid A/TLR4-induced endotoxin tolerance

Repeated exposure to low doses of endotoxin results in progressive hyporesponsiveness to subsequent endotoxin challenge, a phenomenon known as endotoxin tolerance. In spite of its clinical significance in sepsis and characterization of the TLR4 signaling pathway as the principal endotoxin detection mechanism, the molecular determinants that induce tolerance remain obscure. We investigated the role of the TRIF/IFN-beta pathway in TLR4-induced endotoxin tolerance. Lipid A-induced homotolerance was characterized by the down-regulation of MyD88-dependent proinflammatory cytokines TNF-alpha and CCL3, but up-regulation of TRIF-dependent cytokine IFN-beta. This correlated with a molecular phenotype of defective NF-kappaB activation but a functional TRIF-dependent STAT1 signaling. Tolerance-induced suppression of TNF-alpha and CCL3 expression was significantly relieved by TRIF and IFN regulatory factor 3 deficiency, suggesting the involvement of the TRIF pathway in tolerance. Alternatively, selective activation of TRIF by poly(I:C)-induced tolerance to lipid A. Furthermore, pretreatment with rIFN-beta also induced tolerance, whereas addition of IFN-beta-neutralizing Ab during the tolerization partially alleviated tolerance to lipid A but not TLR2-induced endotoxin homo- or heterotolerance. Furthermore, IFNAR1-/- murine embryonal fibroblast and bone-marrow derived macrophages failed to induce tolerance. Together, these observations constitute evidence for a role of the TRIF/IFN-beta pathway in the regulation of lipid A/TLR4-mediated endotoxin homotolerance.     

思连康对肝硬化血浆内毒素影响的研究

目的:探讨益生菌制剂思连康治疗肝硬化内毒素血症的作用机制。方法:采用大鼠肝硬化模型,其中治疗组予以思连康液灌胃治疗,共8周,检测治疗组及对照组血浆内毒素指标;并选取70例肝硬化ChildPugh分级为B级的患者,其中治疗组口服思连康(每次两粒,每日三次)3周,观察治疗前后血浆内毒素变化。结果:思连康治疗组的肝硬化大鼠及患者血浆内毒素均明显低于对照组(p<0.05)。结论:思连康能明显降低肝硬化患者血浆内毒素水平,可作为肝硬化患者的辅助用药。