Romieu M, Riche F, Bousseau A, Szekeli B, Schurando P, Briard C, Payen D
Département d'Anesthésie-Réanimation, Hôpital Universitaire Lariboisière, Paris.
Ann Fr Anesth Reanim. 1990;9(6):525-35. doi: 10.1016/s0750-7658(05)80224-2.
Septic shock remains an acute condition with a bad prognosis and a high mortality rate. This could be related to our incomplete understanding of the pathophysiological mechanisms involved, especially in the immunological field. Recently, several studies have stressed the key role of cytokines. Amongst these, the tumour necrosis factor (TNF) seems to be the most important. This peptide is a hormone secreted by monocytes and macrophages under the effect of various stimuli such as lipopolysaccharides or endotoxin. Giving TNF mimicks the clinical and biological patterns of septic shock. Moreover, high concentrations of TNF have been found in patients suffering from septic shock. Pretreatment with monoclonal antibodies against TNF prevents the occurrence of septic shock after endotoxin administration. TNF acts directly via ubiquitous specific receptors; this probably explains its diffuse activity. The therapeutic implications of these recent advances are not clear. It is not known, for the moment, whether TNF secretion is beneficial or deleterious for the patient.
感染性休克仍然是一种预后不良且死亡率高的急性病症。这可能与我们对所涉及的病理生理机制，尤其是免疫领域的机制理解不完整有关。最近，多项研究强调了细胞因子的关键作用。其中，肿瘤坏死因子（TNF）似乎最为重要。这种肽是单核细胞和巨噬细胞在诸如脂多糖或内毒素等各种刺激作用下分泌的一种激素。给予TNF会模拟感染性休克的临床和生物学模式。此外，在感染性休克患者中发现了高浓度的TNF。用抗TNF单克隆抗体进行预处理可防止内毒素给药后发生感染性休克。TNF通过普遍存在的特异性受体直接发挥作用；这可能解释了其广泛的活性。这些最新进展的治疗意义尚不清楚。目前尚不清楚TNF分泌对患者是有益还是有害。
