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The Second department of Internal Medicine, Kurune University School of Medicine, Kurume, Japan, The present study was designed to evaluate the effect of Polymyxin B on endotoxemia in severe liver diseases. The Limulus Amoebocyte Lysate Test (Limulus Test) was utilized to determine the degree of inactivation of endotoxin by Polymyxin B in vitro. Then, Polymyxin B was administrated orally to 22 patients with liver diseases, including liver cirrhosis (10 cases), hepatoma (10 cases), and obstructive jaundice (2 cases).This study showed that Polymyxin B at the concentration of 0.1 and 0.Olmg/ml reduced the activity of endotoxin at the concentration of 1×10-7mg/ml in Limulus Test. Polymyxin B (300×104 units/day) was administrated orally for 3 days. Before, during and after its administration, endotoxin in serum was detected by Limulus Test. Before its administration, endotoxin in serum was detected in 40% of patients lith liver cirrhosis (4/10) and 50% of patients with hepatoma (5/10). In these cases of endotoxemia, including 4 cases of liver cirrhosis and 4 cases of hepatoma, endotoxin concentration in serum decreased after its administration. In 20% of patients with liver chrrhosis (2/10, both cases were endotoxin positive), 20% of patients with hepatoma (2/10, one case was endotoxin positive) and 100% of patients with obstructive jaundice (2/2, both cases were endotoxin negative), endotoxin concentration in serum increased briefly during its admimistration.In contrast, Kanamycin had no effect on inhibition of pregel coagulation. And, no effect was found on endotoxemia in cases with liver cirrhosis after oral administration of Kanamynin. These results suggest that Polymyxin B is effective in patients with endotoxemia in severe liver diseases because of its bacteriocidal and anti-endotoxin effects. Detergent action of Polymyxin B on endotoxin provides one possible explanation for the mechanism of its inactivation.
財団法人日本消化器病学会の論文

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