Anaesthetics and Critical Care, Gloucestershire Royal Hospital, Gloucestershire Hospitals NHS Foundation Trust, Gloucester, UK.
NIHR Oxford Biomedical Research Centre, John Radcliffe Hospital, Oxford, UK.
J Biol Rhythms. 2022 Aug;37(4):385-402. doi: 10.1177/07487304221092727. Epub 2022 Jun 7.
The Earth's 24-h planetary rotation, with predictable light and heat cycles, has driven profound evolutionary adaptation, with prominent impacts on physiological mechanisms important for surviving critical illness. Pathways of interest include inflammation, mitochondrial function, energy metabolism, hypoxic signaling, apoptosis, and defenses against reactive oxygen species. Regulation of these by the cellular circadian clock (BMAL-1 and its network) has an important influence on pulmonary inflammation; ventilator-associated lung injury; septic shock; brain injury, including vasospasm; and overall mortality in both animals and humans. Whether it is cytokines, the inflammasome, or mitochondrial biogenesis, circadian medicine represents exciting opportunities for translational therapy in intensive care, which is currently lacking. Circadian medicine also represents a link to metabolic determinants of outcome, such as diabetes and cardiovascular disease. More than ever, we are appreciating the problem of circadian desynchrony in intensive care. This review explores the rationale and evidence for the importance of the circadian clock in surviving critical illness.
地球 24 小时的行星自转，伴随着可预测的光和热循环，推动了深刻的进化适应，对生存危重病的重要生理机制产生了显著影响。感兴趣的途径包括炎症、线粒体功能、能量代谢、缺氧信号转导、细胞凋亡和对抗活性氧的防御。这些途径由细胞生物钟（BMAL-1 及其网络）调节，对肺部炎症、呼吸机相关性肺损伤、感染性休克、脑损伤包括血管痉挛以及动物和人类的整体死亡率有重要影响。无论是细胞因子、炎性小体还是线粒体生物发生，生物钟医学代表了重症监护中转化治疗的令人兴奋的机会，而目前重症监护中缺乏这种机会。生物钟医学也代表了与代谢决定因素（如糖尿病和心血管疾病）相关的预后的联系。我们越来越意识到重症监护中昼夜节律失调的问题。这篇综述探讨了生物钟在生存危重病中的重要性的基本原理和证据。
