Pulmonary Center, Boston University School of Medicine , Boston, Massachusetts.
Physiol Rev. 2018 Jul 1;98(3):1417-1464. doi: 10.1152/physrev.00032.2017.
Pneumonia is a type of acute lower respiratory infection that is common and severe. The outcome of lower respiratory infection is determined by the degrees to which immunity is protective and inflammation is damaging. Intercellular and interorgan signaling networks coordinate these actions to fight infection and protect the tissue. Cells residing in the lung initiate and steer these responses, with additional immunity effectors recruited from the bloodstream. Responses of extrapulmonary tissues, including the liver, bone marrow, and others, are essential to resistance and resilience. Responses in the lung and extrapulmonary organs can also be counterproductive and drive acute and chronic comorbidities after respiratory infection. This review discusses cell-specific and organ-specific roles in the integrated physiological response to acute lung infection, and the mechanisms by which intercellular and interorgan signaling contribute to host defense and healthy respiratory physiology or to acute lung injury, chronic pulmonary disease, and adverse extrapulmonary sequelae. Pneumonia should no longer be perceived as simply an acute infection of the lung. Pneumonia susceptibility reflects ongoing and poorly understood chronic conditions, and pneumonia results in diverse and often persistent deleterious consequences for multiple physiological systems.
肺炎是一种常见且严重的急性下呼吸道感染。下呼吸道感染的结果取决于免疫保护和炎症损伤的程度。细胞间和器官间的信号网络协调这些作用以抵抗感染并保护组织。肺内的细胞启动并引导这些反应，同时从血液中招募额外的免疫效应物。包括肝脏、骨髓和其他组织在内的肺外组织的反应对于抵抗和恢复能力至关重要。肺和肺外器官的反应也可能适得其反，并在呼吸道感染后引发急性和慢性合并症。这篇综述讨论了急性肺感染中细胞特异性和器官特异性的作用，以及细胞间和器官间信号在宿主防御和健康呼吸生理学或急性肺损伤、慢性肺病和不良肺外后遗症中的作用机制。肺炎不应再被简单地视为肺部的急性感染。肺炎易感性反映了持续存在且尚未被充分理解的慢性疾病，并且肺炎会对多个生理系统造成多种且常常持续的有害后果。
