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肺炎引起的炎症、消退与心血管疾病:病因、后果及临床机会。

Pneumonia-Induced Inflammation, Resolution and Cardiovascular Disease: Causes, Consequences and Clinical Opportunities.

机构信息

Department of Biochemistry, Microbiology, and Immunology, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada (C.S., K.J.R).

Centre for Infection, Immunity, and Inflammation, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada (C.S., V.F.C.-M.).

出版信息

Circ Res. 2023 Mar 17;132(6):751-774. doi: 10.1161/CIRCRESAHA.122.321636. Epub 2023 Mar 16.

Abstract

Pneumonia is inflammation in the lungs, which is usually caused by an infection. The symptoms of pneumonia can vary from mild to life-threatening, where severe illness is often observed in vulnerable populations like children, older adults, and those with preexisting health conditions. Vaccines have greatly reduced the burden of some of the most common causes of pneumonia, and the use of antimicrobials has greatly improved the survival to this infection. However, pneumonia survivors do not return to their preinfection health trajectories but instead experience an accelerated health decline with an increased risk of cardiovascular disease. The mechanisms of this association are not well understood, but a persistent dysregulated inflammatory response post-pneumonia appears to play a central role. It is proposed that the inflammatory response during pneumonia is left unregulated and exacerbates atherosclerotic vascular disease, which ultimately leads to adverse cardiac events such as myocardial infarction. For this reason, there is a need to better understand the inflammatory cross talk between the lungs and the heart during and after pneumonia to develop therapeutics that focus on preventing pneumonia-associated cardiovascular events. This review will provide an overview of the known mechanisms of inflammation triggered during pneumonia and their relevance to the increased cardiovascular risk that follows this infection. We will also discuss opportunities for new clinical approaches leveraging strategies to promote inflammatory resolution pathways as a novel therapeutic target to reduce the risk of cardiac events post-pneumonia.

摘要

肺炎是肺部的炎症,通常由感染引起。肺炎的症状从轻微到危及生命不等,儿童、老年人和患有先前存在的健康状况的人等脆弱人群中常观察到严重疾病。疫苗大大减轻了一些最常见肺炎病因的负担,抗生素的使用大大提高了对这种感染的存活率。然而,肺炎幸存者并没有恢复到感染前的健康轨迹,而是经历了加速的健康下降,患心血管疾病的风险增加。这种关联的机制尚不清楚,但肺炎后持续失调的炎症反应似乎起着核心作用。据推测,肺炎期间的炎症反应不受调节,加剧了动脉粥样硬化血管疾病,最终导致心肌梗死等不良心脏事件。因此,需要更好地了解肺炎期间和之后肺部和心脏之间的炎症相互作用,以开发专注于预防肺炎相关心血管事件的治疗方法。这篇综述将概述肺炎期间触发的炎症的已知机制及其与随后感染后心血管风险增加的相关性。我们还将讨论利用促进炎症消退途径的新临床方法的机会,作为一种减少肺炎后心脏事件风险的新治疗靶点。

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