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糖皮质激素抵抗合并高乳酸血症导致脓毒症致死性休克。

Combined glucocorticoid resistance and hyperlactatemia contributes to lethal shock in sepsis.

机构信息

VIB Center for Inflammation Research, VIB, Ghent 9052, Belgium; Department of Biomedical Molecular Biology, Ghent University, Ghent 9052, Belgium.

Institute of Biomedicine, University of Eastern Finland, Kuopio 70210, Finland.

出版信息

Cell Metab. 2021 Sep 7;33(9):1763-1776.e5. doi: 10.1016/j.cmet.2021.07.002. Epub 2021 Jul 23.


DOI:10.1016/j.cmet.2021.07.002
PMID:34302744
Abstract

Sepsis is a potentially lethal syndrome resulting from a maladaptive response to infection. Upon infection, glucocorticoids are produced as a part of the compensatory response to tolerate sepsis. This tolerance is, however, mitigated in sepsis due to a quickly induced glucocorticoid resistance at the level of the glucocorticoid receptor. Here, we show that defects in the glucocorticoid receptor signaling pathway aggravate sepsis pathophysiology by lowering lactate clearance and sensitizing mice to lactate-induced toxicity. The latter is exerted via an uncontrolled production of vascular endothelial growth factor, resulting in vascular leakage and collapse with severe hypotension, organ damage, and death, all being typical features of a lethal form of sepsis. In conclusion, sepsis leads to glucocorticoid receptor failure and hyperlactatemia, which collectively leads to a lethal vascular collapse.

摘要

败血症是一种潜在的致命综合征,是对感染的适应性反应失调的结果。感染后,糖皮质激素作为对败血症耐受的代偿反应的一部分而产生。然而,由于糖皮质激素受体水平的糖皮质激素抵抗迅速诱导,这种耐受在败血症中减轻。在这里,我们表明,糖皮质激素受体信号通路的缺陷通过降低乳酸清除率并使小鼠对乳酸诱导的毒性敏感来加重败血症的病理生理学。后者是通过血管内皮生长因子的失控产生来发挥作用的,导致血管渗漏和崩溃,伴有严重低血压、器官损伤和死亡,这些都是致命性败血症的典型特征。总之,败血症导致糖皮质激素受体失效和高乳酸血症,这共同导致致命性血管崩溃。

相似文献

[1]
Combined glucocorticoid resistance and hyperlactatemia contributes to lethal shock in sepsis.

Cell Metab. 2021-9-7

[2]
Glucocorticoid resistance and hyperlactatemia: A tag team to worsen sepsis.

Cell Metab. 2021-9-7

[3]
Reclassifying the spectrum of septic patients using lactate: severe sepsis, cryptic shock, vasoplegic shock and dysoxic shock.

Rev Bras Ter Intensiva. 2013

[4]
Corticosteroid resistance in sepsis is influenced by microRNA-124--induced downregulation of glucocorticoid receptor-α.

Crit Care Med. 2012-10

[5]
Glucocorticoids in Sepsis: To Be or Not to Be.

Front Immunol. 2020

[6]
Hyperlactatemia is an independent predictor of mortality and denotes distinct subtypes of severe sepsis and septic shock.

J Crit Care. 2015-4

[7]
Severe hyperlactatemia, lactate clearance and mortality in unselected critically ill patients.

Intensive Care Med. 2015-11-10

[8]
Lactic Acidosis in Sepsis: It's Not All Anaerobic: Implications for Diagnosis and Management.

Chest. 2016-1-6

[9]
Use of stepwise lactate kinetics-oriented hemodynamic therapy could improve the clinical outcomes of patients with sepsis-associated hyperlactatemia.

Crit Care. 2017-2-16

[10]
Sepsis-associated hyperlactatemia.

Crit Care. 2014-9-9

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[3]
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[4]
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