脓毒症中的器官相互作用与功能障碍。

Organ crosstalk and dysfunction in sepsis.

作者信息

Borges André, Bento Luís

机构信息

Intensive Care Unit of Hospital de São José, Unidade de Urgência Médica, Rua José António Serrano, Lisbon, 1150-199, Portugal.

NOVA Medical School, Campo dos Mártires da Pátria 130, Lisbon, 1169-056, Portugal.

出版信息

Ann Intensive Care. 2024 Sep 19;14(1):147. doi: 10.1186/s13613-024-01377-0.

Abstract

Sepsis is a dysregulated immune response to an infection that leads to organ dysfunction. Sepsis-associated organ dysfunction involves multiple inflammatory mechanisms and complex metabolic reprogramming of cellular function. These mechanisms cooperate through multiple organs and systems according to a complex set of long-distance communications mediated by cellular pathways, solutes, and neurohormonal actions. In sepsis, the concept of organ crosstalk involves the dysregulation of one system, which triggers compensatory mechanisms in other systems that can induce further damage. Despite the abundance of studies published on ​​organ crosstalk in the last decade, there is a need to formulate a more comprehensive framework involving all organs to create a more detailed picture of sepsis. In this paper, we review the literature published on organ crosstalk in the last 10 years and explore how these relationships affect the progression of organ failure in patients with septic shock. We explored these relationships in terms of the heart-kidney-lung, gut-microbiome-liver-brain, and adipose tissue-muscle-bone crosstalk in sepsis patients. A deep connection exists among these organs based on crosstalk. We also review how multiple therapeutic interventions administered in intensive care units, such as mechanical ventilation, antibiotics, anesthesia, nutrition, and proton pump inhibitors, affect these systems and must be carefully considered when managing septic patients. The progression to multiple organ dysfunction syndrome in sepsis patients is still one of the most frequent causes of death in critically ill patients. A better understanding and monitoring of the mechanics of organ crosstalk will enable the anticipation of organ damage and the development of individualized therapeutic strategies.

摘要

脓毒症是机体对感染的一种失调的免疫反应,可导致器官功能障碍。脓毒症相关的器官功能障碍涉及多种炎症机制以及细胞功能的复杂代谢重编程。这些机制通过由细胞途径、溶质和神经激素作用介导的一系列复杂的远距离通讯,在多个器官和系统之间协同作用。在脓毒症中,器官串扰的概念涉及一个系统的失调,这会触发其他系统的代偿机制,进而可能导致进一步的损伤。尽管在过去十年中发表了大量关于器官串扰的研究,但仍需要制定一个涵盖所有器官的更全面的框架,以更详细地描绘脓毒症的情况。在本文中,我们回顾了过去10年发表的关于器官串扰的文献,并探讨了这些关系如何影响感染性休克患者器官衰竭的进展。我们从脓毒症患者的心脏-肾脏-肺、肠道-微生物群-肝脏-大脑以及脂肪组织-肌肉-骨骼串扰的角度探讨了这些关系。基于串扰,这些器官之间存在着深刻的联系。我们还回顾了重症监护病房中实施的多种治疗干预措施,如机械通气、抗生素、麻醉、营养和质子泵抑制剂,如何影响这些系统,以及在管理脓毒症患者时必须仔细考虑这些因素。脓毒症患者进展为多器官功能障碍综合征仍然是重症患者最常见的死亡原因之一。更好地理解和监测器官串扰的机制将有助于预测器官损伤并制定个性化的治疗策略。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/05a9/11413314/12dd52603cb0/13613_2024_1377_Fig1_HTML.jpg

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