Minasyan Hayk
Mamikonyanz 38-38, Yerevan 0014, Armenia.
J Crit Care. 2017 Aug;40:229-242. doi: 10.1016/j.jcrc.2017.04.015. Epub 2017 Apr 18.
The majority of bacteremias do not develop to sepsis: bacteria are cleared from the bloodstream. Oxygen released from erythrocytes and humoral immunity kill bacteria in the bloodstream. Sepsis develops if bacteria are resistant to oxidation and proliferate in erythrocytes. Bacteria provoke oxygen release from erythrocytes to arterial blood. Abundant release of oxygen to the plasma triggers a cascade of events that cause: 1. oxygen delivery failure to cells; 2. oxidation of plasma components that impairs humoral regulation and inactivates immune complexes; 3. disseminated intravascular coagulation and multiple organs' failure. Bacterial reservoir inside erythrocytes provides the long-term survival of bacteria and is the cause of ineffectiveness of antibiotics and host immune reactions. Treatment perspectives that include different aspects of sepsis development are discussed.
细菌会从血液中清除。红细胞释放的氧气和体液免疫会杀死血液中的细菌。如果细菌对氧化具有抗性并在红细胞中增殖，就会发展为脓毒症。细菌促使氧气从红细胞释放到动脉血中。大量氧气释放到血浆中会引发一系列事件，导致：1. 细胞氧气输送失败；2. 血浆成分氧化，损害体液调节并使免疫复合物失活；3. 弥散性血管内凝血和多器官衰竭。红细胞内的细菌储存库使细菌得以长期存活，这是抗生素和宿主免疫反应无效的原因。文中讨论了包括脓毒症发展不同方面的治疗前景。
