肠道——危重症中多器官功能障碍的驱动因素
The Gut as the Motor of Multiple Organ Dysfunction in Critical Illness.
作者信息
Klingensmith Nathan J, Coopersmith Craig M
机构信息
Department of Surgery, Emory Critical Care Center, Emory University School of Medicine, Atlanta, GA, USA.
Department of Surgery, Emory Critical Care Center, Emory University School of Medicine, Atlanta, GA, USA.
出版信息
Crit Care Clin. 2016 Apr;32(2):203-12. doi: 10.1016/j.ccc.2015.11.004. Epub 2016 Feb 4.
All elements of the gut - the epithelium, the immune system, and the microbiome - are impacted by critical illness and can, in turn, propagate a pathologic host response leading to multiple organ dysfunction syndrome. Preclinical studies have demonstrated that this can occur by release of toxic gut-derived substances into the mesenteric lymph where they can cause distant damage. Further, intestinal integrity is compromised in critical illness with increases in apoptosis and permeability. There is also increasing recognition that microbes alter their behavior and can become virulent based upon host environmental cues. Gut failure is common in critically ill patients; however, therapeutics targeting the gut have proven to be challenging to implement at the bedside. Numerous strategies to manipulate the microbiome have recently been used with varying success in the ICU.
肠道的所有组成部分——上皮组织、免疫系统和微生物群——都会受到危重病的影响，进而引发病理性宿主反应，导致多器官功能障碍综合征。临床前研究表明，这可能是由于肠道来源的有毒物质释放到肠系膜淋巴中，从而造成远处损伤。此外，危重病会导致肠道完整性受损，细胞凋亡增加，通透性增强。人们也越来越认识到，微生物会根据宿主环境线索改变其行为并变得具有毒性。肠道功能衰竭在危重病患者中很常见；然而，事实证明，针对肠道的治疗方法在床边实施起来具有挑战性。最近，在重症监护病房（ICU）中使用了许多操纵微生物群的策略，但效果各异。
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