Department of Anesthesiology and Intensive Care, Medical Center of Postgraduate Education, Warsaw, Poland.
Arch Immunol Ther Exp (Warsz). 2012 Apr;60(2):123-35. doi: 10.1007/s00005-012-0166-1.
Septic syndromes are the main cause of death in the intensive care units and although the mortality rates is slowly decreasing, the occurrence of the disease has been increasing. The pathogenesis of sepsis includes countless disturbances of the host immune system starting with a harmful, infection-triggered exaggerated inflammatory cascade, followed by the development of an immunoparalysis state. The latter contributes to the failure in pathogen eradication and leads to secondary infections, which are often the cause of fatal complications. In this review, we consider different novel therapeutic strategies for restoration of immune function. The use of glucocorticoids, intravenous immunoglobulins, heparin, recombinant human activated protein C, granulocyte macrophage colony-stimulating factor, granulocyte colony-stimulating factor, interferon-γ, statins, macrolides and high-volume hemofiltration are discussed. Even though some clinical trials of these regimens are promising, the key to their successful application seems to be the precise monitoring of the status of immune system followed by implementation of the adequate therapy. Thus, in this paper we present disturbances in the immune system in the course of human sepsis, with special attention to the parameters that could be monitored and serve as markers for immunomodulatory therapies. We conclude by briefly presenting the current sepsis treatment strategy.
脓毒症综合征是重症监护病房患者死亡的主要原因，尽管死亡率正在缓慢下降，但该病的发病率一直在上升。脓毒症的发病机制包括宿主免疫系统无数的紊乱，从有害的、感染引发的过度炎症级联反应开始，随后发展为免疫麻痹状态。后者导致病原体清除失败，并导致二次感染，这通常是致命并发症的原因。在这篇综述中，我们考虑了恢复免疫功能的不同新的治疗策略。讨论了糖皮质激素、静脉注射免疫球蛋白、肝素、重组人活化蛋白 C、粒细胞-巨噬细胞集落刺激因子、粒细胞集落刺激因子、干扰素-γ、他汀类药物、大环内酯类药物和高容量血液滤过的使用。尽管这些方案的一些临床试验有希望，但成功应用的关键似乎是精确监测免疫系统的状态，然后实施适当的治疗。因此，本文我们介绍了人类脓毒症过程中免疫系统的紊乱，并特别关注可以监测和作为免疫调节治疗标志物的参数。最后我们简要介绍了当前的脓毒症治疗策略。
