Siegler Benedikt H, Brenner Thorsten, Uhle Florian, Weiterer Sebastian, Weigand Markus A, Hofer Stefan
Department of Anesthesiology, Heidelberg University Hospital, Heidelberg, Germany.
J Thorac Dis. 2016 Jun;8(6):E424-30. doi: 10.21037/jtd.2016.04.37.
Sepsis and septic shock are associated with high mortality rates and remain a serious menace for the critically ill patient. Concurrent activation of pro- and anti-inflammatory pathways and an excessive cytokine release represent initial key features in the deregulation of the humoral and cellular antimicrobial defense. Research of the last decades addressed both the ebullient inflammation as well as the resulting long-term failure of the host immunity. While the reestablishment of an adequate immune-competence is still under investigation, many promising experimental trials to limit the inflammatory response during sepsis were challenged by missing beneficial effects in clinical studies. Nevertheless, due to advanced knowledge about the complex regulation of inflammatory mediators and their overlapping involvement in other potentially life-threatening diseases, further evaluation of these approaches in relevant subgroups could help to identify critically ill patients with potential benefit from anti-inflammatory therapies.
脓毒症和脓毒性休克与高死亡率相关，仍然是重症患者面临的严重威胁。促炎和抗炎途径的同时激活以及细胞因子的过度释放是体液和细胞抗菌防御失调的初始关键特征。过去几十年的研究既关注了旺盛的炎症反应，也关注了随之而来的宿主免疫长期功能障碍。虽然恢复足够的免疫能力仍在研究中，但许多旨在限制脓毒症期间炎症反应的有前景的实验性试验在临床研究中却因缺乏有益效果而受到挑战。然而，由于对炎症介质复杂调节及其在其他潜在危及生命疾病中的重叠参与有了更深入的了解，在相关亚组中对这些方法进行进一步评估可能有助于识别可能从抗炎治疗中获益的重症患者。
