Karzai W, Reinhart K
Klinik für Anästhesiologie und Intensivtherapie, Klinikum der Friedrich-Schiller-Universität, Jena, Germany.
Int J Clin Pract Suppl. 1998 Jun;95:44-8.
There have been many attempts to provide a uniform definition for the diagnosis of sepsis that can be used for research and clinical purposes. Several definitions are too broad and, as a result, clinicians are unable to direct appropriate therapies to patients. Disappointing immunomodulatory trials have led many researchers to the conclusion that the current diagnostic criteria of sepsis fails to identify patients who could benefit from immunomodulatory therapies. In order to restore clinical and experimental relevance, many researchers and clinicians believe that sepsis should be defined as an inflammatory response to infection with signs of remote organ dysfunction. However, because common clinical signs of systemic inflammation are neither specific nor sensitive for sepsis, other markers may be helpful. Markers of the systemic inflammatory response to infection could include cytokines such as tumour necrosis factor alpha, interleukin 1, 6 and 8 and the propeptide procalcitonin. As well as identifying patients who may benefit from pro- or anti-inflammatory therapies, these markers may gauge the extent of the inflammatory response and could be used for monitoring the immune status of the patient.
为了为脓毒症的诊断提供一个可用于研究和临床目的的统一定义，人们进行了多次尝试。有几个定义过于宽泛，结果导致临床医生无法为患者制定恰当的治疗方案。令人失望的免疫调节试验使许多研究人员得出结论，即目前脓毒症的诊断标准未能识别出可从免疫调节治疗中获益的患者。为了恢复临床和实验的相关性，许多研究人员和临床医生认为，脓毒症应被定义为对感染的炎症反应并伴有远处器官功能障碍的迹象。然而，由于全身炎症的常见临床体征对脓毒症既不具有特异性也不具有敏感性，其他标志物可能会有所帮助。对感染的全身炎症反应的标志物可能包括细胞因子，如肿瘤坏死因子α、白细胞介素1、6和8以及前降钙素原。除了识别可能从促炎或抗炎治疗中获益的患者外，这些标志物还可以评估炎症反应的程度，并可用于监测患者的免疫状态。
