脓毒症中抗血小板药物的应用:未来一瞥。
Use of antiplatelet agents in sepsis: a glimpse into the future.
机构信息
Department of Internal Medicine, University General Hospital of Patras, 26504, Rio, Greece.
Department of Cardiology, University General Hospital of Patras, 26504, Rio, Greece.
出版信息
Thromb Res. 2014 Feb;133(2):131-8. doi: 10.1016/j.thromres.2013.07.002. Epub 2013 Oct 6.
As mechanisms of sepsis pathophysiology have been elucidated with time, sepsis may be considered nowadays, as an uncontrolled inflammatory and pro-coagulant response to a pathogen. In this cascade of events, platelets play a key role, via interaction with endothelial cells and modulation of both innate and adaptive immune system. In that manner, inhibition of platelet function could represent a useful tool for attenuating inflammatory response and improving outcomes. Data on current antiplatelet agents, including acetylsalicylic acid, P2Y12 inhibitors and GPIIb/IIIa antagonists, in animal models are promising. Clinical data in patients hospitalized for pneumonia, at risk for acute lung injury, and/or critically ill revealed an association between antiplatelet therapy and reduction in both short-term mortality and prevalence of acute lung injury, as well as, the need for intensive care unit admission, without a concomitant increased bleeding risk. In need of innovative approach in the treatment of sepsis, further prospective, interventional, randomized trials are pivotal to establish potential use of antiplatelet agents in this context.
随着对脓毒症病理生理学机制的不断阐明,如今可以将其视为机体对病原体产生的失控性炎症和促凝反应。在这一连串的事件中,血小板通过与内皮细胞相互作用以及调节先天和适应性免疫系统而发挥关键作用。因此,抑制血小板功能可能是减轻炎症反应和改善预后的有效工具。目前关于抗血小板药物的数据,包括乙酰水杨酸、P2Y12 抑制剂和 GPIIb/IIIa 拮抗剂,在动物模型中显示出良好的效果。在因肺炎住院、有发生急性肺损伤风险和/或病情危重的患者中进行的临床研究表明,抗血小板治疗与短期死亡率和急性肺损伤发生率的降低相关,同时也降低了入住重症监护病房的需求,而不会增加出血风险。在需要创新的脓毒症治疗方法的情况下,进一步的前瞻性、干预性、随机试验对于确定抗血小板药物在这方面的潜在用途至关重要。