Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Department of Surgery and Emory Critical Care Center, Emory University School of Medicine, Atlanta, Georgia, USA.
Surg Infect (Larchmt). 2023 Apr;24(3):250-257. doi: 10.1089/sur.2022.420.
The gut has been hypothesized to be the "motor" of multiple organ dysfunction in sepsis. Although there are multiple ways in which the gut can drive systemic inflammation, increasing evidence suggests that the intestinal microbiome plays a more substantial role than previously appreciated. An English language literature review was performed to summarize the current knowledge of sepsis-induced gut microbiome dysbiosis. Conversion of a normal microbiome to a pathobiome in the setting of sepsis is associated with worsened mortality. Changes in microbiome composition and diversity signal the intestinal epithelium and immune system resulting in increased intestinal permeability and a dysregulated immune response to sepsis. Clinical approaches to return to microbiome homeostasis may be theoretically possible through a variety of methods including probiotics, prebiotics, fecal microbial transplant, and selective decontamination of the digestive tract. However, more research is required to determine the efficacy (if any) of targeting the microbiome for therapeutic gain. The gut microbiome rapidly loses diversity with emergence of virulent bacteria in sepsis. Restoring normal commensal bacterial diversity through various therapies may be an avenue to improve sepsis mortality.
肠道被假设为脓毒症多器官功能障碍的“发动机”。尽管肠道有多种方式引发全身炎症，但越来越多的证据表明，肠道微生物组的作用比以前认为的更为重要。进行了一项英文文献综述，以总结目前关于脓毒症引起的肠道微生物组失调的知识。在脓毒症的情况下，将正常微生物组转化为病理生物组与死亡率的增加有关。微生物组组成和多样性的变化信号传递给肠上皮和免疫系统，导致肠道通透性增加和对脓毒症的免疫反应失调。通过各种方法（包括益生菌、益生元、粪便微生物移植和消化道选择性去污染）恢复微生物组平衡的临床方法在理论上是可能的。然而，需要更多的研究来确定针对微生物组进行治疗以获得疗效（如果有的话）。肠道微生物组在脓毒症中出现毒力细菌时迅速失去多样性。通过各种治疗方法恢复正常共生细菌的多样性可能是提高脓毒症死亡率的一种途径。
