血中エンドトキシン測定のための新しい血漿処理法の開発とその臨床的意義 : 肝疾患における検討

Abstract

Plasma endotoxin was measured in 31 patients with alcoholic liver diseases and in 90 patients with liver cirrhosis by the chromogenic substrate assay in which plasma was pretreated by an improved method. Pretreatment of plasma with perchloric acid yielded a soluble fraction (supernatant) and an insoluble fraction (precipitate) ; the super- natant was neutralized with 0.18 M sodium hydoxide and the precipitate was solubilized and neutralized by adding 10% triethylamine. Endotoxin concentrations in these two fractions were measured by the use of S-2423 or endotoxin-specific Endospecy as a sub- strate. Irrespective of substrates, a greater part of plasma endotoxin was recovered from the precipitate in patients with liver cirrhosis. When total endotoxin concentration in plasma from cirrhotic patients was calculated by the new acid method, it correlated well to several parameters of liver function including total bilirubin, albumin, prothrombin time and cholinesterase. Endotoxin concentrations were notably elevated in patients with Child C cirrhosis. The elevation of plasma endotoxin was prominent in with poor prognosis, variceal bleeding or advanced hepatoma. Plasma endotoxin detected by this new method may become a useful clinical parameter to predict the outcome of liver diseases.