Remick Daniel G
Boston University School of Medicine, Boston, MA, USA.
Am J Pathol. 2007 May;170(5):1435-44. doi: 10.2353/ajpath.2007.060872.
Sepsis remains a critical problem with significant morbidity and mortality even in the modern era of critical care management. Multiple derangements exist in sepsis involving several different organs and systems, although controversies exist over their individual contribution to the disease process. Septic patients have substantial, life-threatening alterations in their coagulation system, and currently, there is an approved therapy with a component of the coagulation system (activated protein C) to treat patients with severe sepsis. Previously, it was believed that sepsis merely represented an exaggerated, hyperinflammatory response with patients dying from inflammation-induced organ injury. More recent data indicate that substantial heterogeneity exists in septic patients' inflammatory response, with some appearing immuno-stimulated, whereas others appear suppressed. Cellular changes continue the theme of heterogeneity. Some cells work too well such as neutrophils that remain activated for an extended time. Other cellular changes become accelerated in a detrimental fashion including lymphocyte apoptosis. Metabolic changes are clearly present, requiring close and individualized monitoring. At this point in time, the literature richly illustrates that no single mediator/system/pathway/pathogen drives the pathophysiology of sepsis. This review will briefly discuss many of the important alterations that account for the pathophysiology of sepsis.
即使在现代重症监护管理时代，脓毒症仍然是一个严重的问题，具有显著的发病率和死亡率。脓毒症存在多种紊乱，涉及几个不同的器官和系统，尽管对于它们各自在疾病过程中的作用存在争议。脓毒症患者的凝血系统存在严重的、危及生命的改变，目前有一种针对凝血系统成分（活化蛋白C）的获批疗法用于治疗严重脓毒症患者。以前，人们认为脓毒症仅仅代表一种过度的、高炎症反应，患者死于炎症诱导的器官损伤。最近的数据表明，脓毒症患者的炎症反应存在很大的异质性，一些患者表现为免疫刺激，而另一些患者则表现为免疫抑制。细胞变化延续了异质性的主题。一些细胞功能亢进，如长时间保持活化状态的中性粒细胞。其他细胞变化以有害的方式加速，包括淋巴细胞凋亡。代谢变化明显存在，需要密切和个体化的监测。目前，文献充分表明，没有单一的介质/系统/途径/病原体驱动脓毒症的病理生理学。本综述将简要讨论许多导致脓毒症病理生理学的重要改变。
