Prucha Miroslav, Zazula Roman, Russwurm Stefan
Department of Clinical Biochemistry, Hematology and Immunology, Hospital Na Homolce, Prague, Czech Republic.
Department of Anesthesiology and Intensive Care, First Faculty of Medicine, Charles University in Prague and Thomayer Hospital, Prague, Czech Republic.
Arch Immunol Ther Exp (Warsz). 2017 Feb;65(1):37-49. doi: 10.1007/s00005-016-0415-9. Epub 2016 Aug 24.
Sepsis is the most frequent cause of death in noncoronary intensive care units. In the past 10 years, progress has been made in the early identification of septic patients and their treatment. These improvements in support and therapy mean that mortality is gradually decreasing, however, the rate of death from sepsis remains unacceptably high. Immunotherapy is not currently part of the routine treatment of sepsis. Despite experimental successes, the administration of agents to block the effect of sepsis mediators failed to show evidence for improved outcome in a multitude of clinical trials. The following survey summarizes the current knowledge and results of clinical trials on the immunotherapy of sepsis and describes the limitations of our knowledge of the pathogenesis of sepsis. Administration of immunomodulatory drugs should be linked to the current immune status assessed by both clinical and molecular patterns. Thus, a careful daily review of the patient's immune status needs to be introduced into routine clinical practice giving the opportunity for effective and tailored use of immunomodulatory therapy.
脓毒症是非冠心病重症监护病房中最常见的死亡原因。在过去10年里，脓毒症患者的早期识别及其治疗取得了进展。支持治疗和疗法的这些改进意味着死亡率正在逐渐下降，然而，脓毒症的死亡率仍然高得令人无法接受。免疫疗法目前并非脓毒症常规治疗的一部分。尽管实验取得了成功，但在众多临床试验中，使用阻断脓毒症介质作用的药物未能显示出改善预后的证据。以下综述总结了目前关于脓毒症免疫疗法的知识和临床试验结果，并描述了我们对脓毒症发病机制认识的局限性。免疫调节药物的使用应与通过临床和分子模式评估的当前免疫状态相关联。因此，需要在常规临床实践中引入对患者免疫状态的每日仔细评估，以便有机会有效且针对性地使用免疫调节疗法。
