脓毒症相关性器官功能障碍的病理生理学和分子基础的最新进展:新的治疗意义和挑战。
Recent advances in the pathophysiology and molecular basis of sepsis-associated organ dysfunction: Novel therapeutic implications and challenges.
机构信息
Department of Molecular and Medical Pharmacology, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Sugitani 2630, Toyama 930-0194, Japan.
Department of Anesthesiology and Pain Relief Center, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
出版信息
Pharmacol Ther. 2017 Sep;177:56-66. doi: 10.1016/j.pharmthera.2017.02.040. Epub 2017 Feb 21.
Sepsis is one of the most common reasons for critically ill patients to be admitted to an intensive care unit and, despite advances in overall medical care, it represents a major clinical problem and remains the leading cause of death in the critically ill patient population. Although sepsis has been defined as a systemic inflammatory syndrome, in which there is an identifiable focus of infection, clinical trials aimed at anti-inflammatory therapeutic approaches have largely failed to identify an effective therapeutic target to improve clinical outcomes in sepsis. Very recently, the third international consensus definitions have been advocated for sepsis and septic shock. Thus, sepsis is now defined as life-threatening organ dysfunction due to a dysregulated host response to infection. A better understanding of the molecular mechanisms involved in the pathogenesis of sepsis and its resultant organ failure has been sought, and the development of therapies targeted at preventing or limiting molecular events associated with the progress of fatal organ failure, hence leading to improvement of outcomes, is urgently needed. This review article provides an overview of possible pathogenic mechanisms underlying the development of multiple organ dysfunction in sepsis and discusses pharmacological agents regarded as promising in treatment of this disorder.
脓毒症是导致危重症患者入住重症监护病房的最常见原因之一,尽管整体医疗水平有所提高,但它仍是一个主要的临床问题,仍然是危重症患者死亡的主要原因。尽管脓毒症已被定义为一种全身炎症综合征,其中存在可识别的感染灶,但旨在针对抗炎治疗方法的临床试验在很大程度上未能确定改善脓毒症临床结局的有效治疗靶点。最近,已经提倡使用第三次国际共识定义来定义脓毒症和脓毒性休克。因此,脓毒症现在被定义为由于宿主对感染的失调反应而导致危及生命的器官功能障碍。人们一直在努力更好地了解脓毒症发病机制及其导致的器官衰竭中涉及的分子机制,并迫切需要开发针对预防或限制与致命器官衰竭进展相关的分子事件的疗法,从而改善结局。本文综述了脓毒症多器官功能障碍发展的可能发病机制,并讨论了被认为对治疗这种疾病有希望的药物。