, , .

1998 .
(Journal of Immunological Methods [Romaschin AD, et al. 1998; 212:169-185]).

(Endotoxin Activity Assay)
. . , , . , , .
.

.
( 30 !), . ,
.
, FDA.
Berthold SmartLine TL (
).

/
, 117437, , . , . 11, . 1. ./: +7 (495) 544-3902
info@bbmed.ru www.bbmed.ru

 Toraymyxin

,

(). () ,
(, , ).
,
.
- , () 1, 2).
. ,
30 70%3).

(max)

63

135 5

( )

56 3

< 250 . . .

500 . . .

OH

()

100 (80120) /

500 . (4 /)

225

3 000 , 20 / /

.
2 000 /

O
HO

O NH

HO

HO

HO

O NH

, 20200 /,

(Pi) (Po),
,
12F 14F



-

14

CD

TL
MD R4
-2

(O2-, H2O2, NO,...)

(PGE2, PGI2,...)

NFB

(TF, PAI-1,...)

(TNF, IL-1, IL-6,...)

- 4
(TLR4) MD-2, , 4.

1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.

Vincent JL et al.: Microvascular dysfunction as a cause of organ dysfunction in severe sepsis, Crit Care 9: S9-S12, 2005
Abraham E et al.: Mechanisms of sepsis-induced organ dysfunction, Crit Care Med 35: 2408-2416, 2007
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Stewart I, et al.: Cyanobacterial lipopolysaccharides and human health a review. Environ Health 5: 1-23, 2006
Kuhlen R. et al. eds.: 25 years of progress and innovation in intensive care medicine. (Berlin: Medizinisch Wissenschaftliche
Verlagsgesellschaft, 2007), 163-176.
Marshall JC et al.: Diagnostic and prognostic implications of endotoxemia in critical illness: results of the MEDIC study, J Infect Dis 190:
527-534, 2004
MacFie J. et al.: Bacterial tranlocation studies in 927 patients over 13 years. Br J Surg 93 : 87-93, 2006
Shoji H et al.: Extracorporeal endotoxin removal by polymyxin B immobilized fiber cartridge: designing and antiendotoxin efficacy in the
clinical application. Ther Apher 2: 3-12, 1998
Cardoso LS, et al.: Polymyxin B as inhibitor of LPS contamination of Schistosoma mansoni recombinant proteins in human cytokine
analysis. Microb Cell Fact 6: 1-6, 2007
Aoki H et al.: Treatment of sepsis by extracorporeal elimination of endotoxin using polymyxin B-immobilized fiber. Am J Surg 167:
412-417, 1994
Vesentini S. et al.: Multi-scale analysis of the toraymyxin adsorption cartridge. Part I: molecular interaction of polymyxin B with
endotoxins. Int J Artif Organs 29: 239-250, 2006
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Plasmapheresis (XII): 837-842, 1993
Cruz DN, et al.: Effectiveness of polymyxin B-immobilized fiber column in sepsis: a systematic review. Crit Care 11: 1-12, 2007
Shimizu T et al.: The clinical significance of serum procalcitonin levels following direct hemoperfusion with polymyxin B-immobilized
fiber column in septic patients with colorectal perforation. Eur Surg Res 42: 109-117, 2009
Kushi H et al.: Early hemoperfusion with an immobilized polymyxin B fiber column eliminates humoral mediators and improves
pulmonary oxygenation. Critical Care 9: R653-661, 2005
Cruz DN, Antonelli M, Fumagalli R. et al.: Early use of polymyxin B hemoperfusion in abdominal septic shock: the EUPHAS randomized
controlled trial. JAMA 301: 2445-2452, 2009

 Toraymyxin

Toraymyxin
, :

()

()

Toraymyxin

6).
, , , , , 4, 7). , 8).
, 9).

Toraymyxin ,
, 10).
, 11). Toraymyxin 12).

()
(*)

ToraymyxinTM
Femoral V.

* ,
, :

()

(1)
( > 38
C < 36
C)
(2) ( > 90 /)
(3) ( > 20 /,
PaCO2 < 32 ...)
(4) > 12 000 /3,
< 4000 /3 > 10 %
()

O
O

O
O

HO

NH
O

HO

O
O
O

NH
O
HO

Toraymyxin. EUPHAS Toraymyxin
24 18).

NH2

NH2

polymyxin B

OH

xin
:
o
T raymy
:

HO

()

Toraymyxin

Femoral V.

NH

NH2
NH2
CH2NHCOCH2Cl

...

CH2CH

...

CH2NHCOCH2

CH2CH

...

CH2NHCOCH2Cl

CH2CH

...

(Phe, Leu)
;
, ,
,
13).


(Toraymyxin). in vitro ( )
Toraymyxina 64000 14).

Toraymyxin

Toraymyxin'

Toraymyxin ,

Toraymyxina15). Toraymyxin'a , () , , /.
, Toraymyxin' PaO2/FiO2.

, 7). , IL-6,
PAI-1 , ,
. Toraymyxin IL-616) PAI-117).

EUPHAS ,
,
18).

Toraymyxin'

-6 (IL-6)

aO2/FiO2
P

32

12

19

.
. .

, -17,5)

24,9
95% CI (p<0,001

, 455

50 000

()

24
Toraymyxin Toraymyxina Toraymyxina

p<0,05

180

p<0,05

PAI-1 (/)

61,5
33,5
xin

Toraymy

Toraymyxin' 0,53
95% CI (0,43, 0,65) p<0,001.
15 , 920

p=0,036

p=0,011

SOFA

SOFA

SOFA

p=NS

0
-1
-2
-3

SOFA

Toraymyxin

(SOFA)
. SOFA,

72 ,
Toraymyxin.
72
Toraymyxin
SOFA, - SOFA SOFA.
SOFA ,
, .

Toraymyxin
80

120
100
80

40

(SSC)

PAI-1: -1

140

60

p<0,001

-4

(%)

20

-
Toraymyxin.
[ 17)]

160

80

72

in
Toraymyx

24

SOFA 72

(%)
100

(30

-1 (PAI-1)

40

24

10 000
0

,

(SSC) ( : 30 ),
Toraymyxin ( Toraymyxin: 34 ) .
2 ,
24 .

30 000

3,3, -0,4)
95% CI (p=0,01

, 96

17

60

Toraym

4
6

IL-6: -6

40 000

yxin (3

20 000

//
/

21,2

1,8

60 000

Toraymyxin. [
16)]

SOFA

5, 22)
95% CI (1
p<0,001

5
, 27

3, 41)
95% CI (2
p<0,001

1
, 15

IL-6 (/)

p<0,05

70 000

Toraymyxin
- 24

Toraymyxin

48

72

60

68%

59%

SOFA, Toraymyxin
28- (21 %) (26 %)
.

47%
33%

40
20
0

Toraymyxin

28-