白藜芦醇对脓毒症诱导机体损伤的保护作用及机制研究进展

脓毒症是严重的全身化脓性感染,可引起休克、多器官功能障碍,具有高发病率、高病死率、高治疗费用的三高特点,而且其发病率每年还在以1.5%~1.8%的速度增长。脓毒症可以直接导致患者多脏器功能衰竭,是引起重症患者死亡的主要原因之一。虽然人们对脓毒症发病机制的认识越来越深,但是目前的治疗措施,如抗炎、抗氧化、抗血小板聚集和抗微循环衰竭等,仍然未能明显减低患者死亡的风险。目前,研究者发现植物的提取及合成试剂白藜芦醇具有明显的抗炎、抗氧化作用,可以改善脓毒症引起的机体损伤状况,提高生存率,但是其具体作用机制未能完全明确。本综述总结了白藜芦醇在脓毒症导致的机体损伤中的保护作用机制,为今后脓毒症治疗的研究方向提供新的理论。     

脓毒症心肌病发病机制研究进展

脓毒症是机体对感染反应失调引起的危及生命的器官功能障碍综合征,脓毒症心肌病是继发于脓毒症的严重心脏并发症,由机体对感染反应失调引起免疫系统反应紊乱而导致心脏功能障碍、心肌损伤,能显著增加脓毒症的病死率。脓毒症心肌病的发病机制尚不明确,目前已报道的研究指出脓毒症心肌病产生的主要原因有：异常的钙信号、线粒体功能障碍、心肌细胞炎症损伤、血流动力学的改变、氧化应激反应。本文将从以上几点对脓毒症心肌病发病机制进行综述。     

脓毒症致急性肾损伤的机制及治疗研究进展

脓毒症是指由细菌、病毒或真菌感染诱发的全身炎症反应[1],可以导致休克、多器官功能障碍综合征(MODS),甚至死亡.目前脓毒症已成为重症监护病房(ICU)患者死亡的主要原因,是1～4岁儿童的第7大致死原因和65～ 75岁老人的第8大致死原因.急性肾损伤(AKI)是脓毒症发展过程中最常见、最严重的并发症之一,以急性肾衰竭(ARF)为特征,表现为血液过滤不充分,水、离子调节及尿液产生障碍[2].AKI的发病率会随脓毒症的严重程度而增加,脓毒症合并AKI后病死率增加1倍,并且明显高于其他因素导致的ARF[3].随着对脓毒症研究的不断深入,人们对脓毒症引起的肾损伤机制及治疗也逐渐有了新的认识.现针对近期研究,阐述脓毒症引起的AKI机制及临床治疗策略.     

右美托咪定对脓毒症大鼠早期和晚期炎症介质表达的影响

脓毒症是目前引起重症监护病房(ICU)患者死亡的主要原因之一[1].近些年,尽管人们对脓毒症发病机制进行了一定的研究,也提出了针对其早期炎症因子如肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)的靶点治疗,可是脓毒症的病死率仍高达50％左右,严重威胁着人们的健康[2].右美托咪定(DEX)是一种高选择性的α2-肾上腺素能受体激动剂,具有镇静、镇痛、遗忘、抗焦虑、无呼吸抑制等特点[3].有研究报道,DEX可降低脓毒症大鼠的死亡率并抑制其炎症反应[4-6],但有关DEX对脓毒症大鼠晚期炎症因子高迁移率族蛋白B1 (HMGB1)影响的研究报道甚少.本研究中拟采用盲肠结扎穿孔术(CLP)制备大鼠脓毒症模型,并用DEX进行干预,评价DEX对TNF-α、IL-6和HMGB1的影响.     

脓毒症与铁代谢的研究进展

脓毒症是一种由感染引起的常见的全身炎症反应综合征,具有高发病率和高病死率的特征,已成为重要的公共健康问题之一。脓毒症及其发病机制和治疗也一直是研究重点。2016年,脓毒症被重新定义为由宿主对感染的反应失调引起的危及生命的器官功能障碍模式。近年来,针对脓毒症患者的免疫反应及代谢变化开展了大量临床及实验研究,其中铁代谢与脓毒症的关系也是研究重点之一。铁在调节免疫功能和微生物生长方面有着关键作用,已有研究证明铁代谢的变化会影响感染的风险。本文旨在对铁代谢与脓毒症及脓毒症诱导的多器官功能障碍的关系等作简要概述,以期对脓毒症的预后预测及治疗提供新的方向。     

白细胞分化抗原-14（CD14）的研究进展

脓毒症（sepsis）是指由感染引起的全身炎症反应综合征,是创伤、烧伤、休克、感染等临床急危重患者的严重并发症之一,也是诱发脓毒性休克、多器官功能障碍综合征的重要原因。宿主对感染因素的识别是脓毒症启动的第一步。随着对脓毒症的发病机制的深入研究,人们发现白细胞分化抗原-14（clus-terofdifferentiation14,CD14）发挥着重要作用。     

脓毒症心肌病的诊疗进展北大核心CSCD

脓毒症是宿主对感染的反应失调引起的危及生命的器官功能障碍[1],是重症监护病房患者死亡的主要原因之一。最新流行病学研究显示,全球每年脓毒症相关死亡达1100万左右[2]。脓毒症心肌病(sepsis-induced cardiomyopathy,SC)是脓毒症引起的心脏可逆性的功能障碍,病死率高,临床尚无确定诊断标准。     

脓毒症抗凝治疗的研究现状

脓毒症是由感染引起的全身炎症反应综合征,可进一步发展为严重脓毒症、脓毒症休克及多器官功能障碍综合征,是急危重症医学面临的突出难题,其病死率较高.脓毒症的发病机制十分复杂,近年研究发现,凝血系统异常在脓毒症病程中具有重要作用,抗凝治疗已经成为脓毒症治疗的有效手段之一.该文就脓毒症抗凝治疗的研究现状作一综述,并对存在的问题...     

血小板功能与脓毒症

由脓毒症促发的全身失控的炎症反应和多脏器功能障碍综合征 (MODS)是目前ICU危重病人死亡的主要病理因素 ,骨髓往往是其最受累的器官之一。其具体表现于外周血中出现血液内有形成分的异常 ,尤其是血小板对细菌毒素十分敏感 ,在严重感染的早期就有所表现。危重病人血小板进行性下降往往提示病人存在严重的脓毒症且预后较差[1 ] ,因此 ,血小板又重新作为脓毒症中关键因素引起人们的注意。然而 ,目前有关血小板在脓毒症中的功能作用研究还很少。一些研究初步显示 ,血小板在脓毒症中可能起着非常复杂的作用 ;它不仅可以调节自身的功能 ,而且…     

脓毒症心肌病的诊疗进展

脓毒症是宿主对感染的反应失调引起的危及生命的器官功能障碍[1], 是重症监护病房患者死亡的主要原因之一。最新流行病学研究显示, 全球每年脓毒症相关死亡达1 100万左右[2]。脓毒症心肌病(sepsis-induced cardiomyopathy, SC)是脓毒症引起的心脏可逆性的功能障碍, 病死率高, 临床尚无确定诊断标准。     

机器学习在脓毒症诊治中的研究进展

脓毒症是全球医疗面临的巨大挑战，目前存在的问题主要在于诊断的滞后性和治疗的非特异性。机器学习是从数据中生成知识的数据分析和建模技术，它通过预测未来事件为患者提供警报和建议，帮助临床医师获得经验之外的信息，从而辅助临床决策。近年来，机器学习在脓毒症领域的关注度不断升温，在脓毒症临床诊断、精准治疗和预后评估方面取得了一些突破性的进展，有望构建脓毒症诊断和治疗的新体系。本文对相关文章进行回顾，旨在明确机器学习目前在脓毒症诊疗方面的研究进展，为进一步研究提供方向。     

从脓毒症诊治观念变迁看肾上腺皮质激素的应用

脓毒症是病原微生物感染引发的危及生命的器官功能障碍。由于病理生理机制的复杂性，自1991年对其概念的界定以来，已历经3次重要修订，但仍难以形成广泛共识。特别是在拯救脓毒症运动背景下，脓毒症发病率和死亡率居高不下、特效药物匮乏以及诸多经验性救治措施难以奏效的严峻现实表明，脓毒症非病原依赖性瀑布样介质反应尚有广阔的探索空间。肾上腺作为神经-内分泌-免疫调控网络的重要效应器官，通过接驳中枢应激信号和局部微环境反应，以效应激素形式参与对脓毒症机体反应的非线性、复杂性调控。其功能障碍的早期识别、替代治疗以及在脓毒症机体紊乱内环境中的再认识，无疑是脓毒症诊治的核心环节之一。近30年来，针对肾上腺皮质激素的多项临床研究以及争议性推荐意见进一步凸显其重要价值。为此，笔者基于预测性、预防性、个体化、参与性的"4P"医学模式，立足转化医学视角，从脓毒症定义及其内涵的变化，分析肾上腺皮质激素的诊治价值，并从内源性和外源性肾上腺皮质激素角度，阐述脓毒症治疗中基于神经-内分泌-免疫网络的微环境调控理论，尝试从肾上腺皮质激素(种类、用量、单独和联合治疗、时间窗)分析脓毒症理论研究瓶颈与临床实践困惑，旨在为脓毒症的肾上腺皮质激素应用提供有益的借鉴和启示。     

新型感染标志物在脓毒症早期诊断中的应用及研究进展

脓毒症(sepsis)是感染引起宿主反应失调,导致危及生命的器官功能障碍症候群,病情危急,死亡率高.血培养是诊断的金标准,但培养及鉴定时间较长,而临床治疗需要在脓毒症早期杀灭病原菌以控制患者病情,提高治愈率,减少用药时间,降低死亡率.因此,迫切需要能够快速、准确诊断早期脓毒症的实验室指标以指导临床抗生素治疗.血清炎性介...     

Acute bacterial rhinosinusitis in adults: part I. Evaluation

Acute rhinosinusitis is one of the most common conditions that physicians treat in ambulatory practice. Although often caused by viruses, it sometimes is caused by bacteria, a condition that is called acute bacterial rhinosinusitis. The signs and symptoms of acute bacterial rhinosinusitis and prolonged viral upper respiratory infection are similar, which makes accurate clinical diagnosis difficult. Because two thirds of patients with acute bacterial rhinosinusitis improve without antibiotic treatment and most patients with viral upper respiratory infection improve within seven d antibiotic therapy should be reserved for use in patients who have had symptoms for more than seven days and meet clinical criteria. Four signs and symptoms are the most helpful in predicting acute bacterial rhinosinusitis: purulent nasal discharge, maxillary tooth or facial pain (especially unilateral), unilateral maxillary sinus tenderness, and worsening symptoms after initial improvement. Sinus radiography and ultrasonography are not recommended in the diagnosis of uncomplicated acute bacterial rhinosinusitis, although computed tomography has a role in the care of patients with recurrent or chronic symptoms.     

Clinical laboratory differentiation of infectious versus non-infectious systemic inflammatory response syndrome

OBJECTIVE: To evaluate the accuracy of C-reactive protein (CRP), procalcitonin (PCT), neopterin, and endotoxin in the differential diagnosis of sepsis and non-infectious systemic inflammatory response syndrome (SIRS). METHODS: A Medline database and references from identified articles were used to perform a literature search relating to the differential diagnosis of sepsis versus non-infectious SIRS. RESULTS: CRP, PCT, and neopterin are released both in sepsis and in non-infectious inflammatory disease. CRP and PCT are equally effective, although not perfect, in differentiating between sepsis and non-infectious SIRS. However, CRP and PCT have different kinetics and profiles. The kinetics of CRP is slower than that of PCT, and CRP levels may not further increase during more severe stages of sepsis. On the contrary, PCT rises in proportion to the severity of sepsis and reaches its highest levels in septic shock. PCT tends to be higher in nonsurvivor than in survivor. Therefore, PCT demonstrated a closer correlation with the severity of sepsis and outcome than CRP. Unlike CRP and PCT, neopterin is increased in viral infection as well as bacterial infection, and neopterin is also a useful indicator of sepsis. Endotoxemia was detected in no more than half of patients with Gram-negative bacteremia, and Gram-negative bacteremia was detected in half of patients with endotoxemia. CONCLUSIONS: The diagnostic capacity of PCT is superior to that of CRP due to the close correlation between PCT levels and the severity of sepsis and outcome. Neopterin is very useful in the diagnosis of viral infection. The endotoxin assay in combination with CRP, PCT, or neopterin may help as a diagnostic marker for Gram-negative bacterial infection.     

脓毒症实验室诊断及其研究进展

脓毒症是一类因多种病原菌引起的机体全身性的过度炎症反应,临床症状与全身性炎症反应综合征(SIRS)相似,由于目前缺少理想的实验室诊断指标,尽管近年来诊断和治疗的技术不断进步,但脓毒症发生率和死亡率仍居高不下。本文就近几年临床应用较多、研究较热门的诊断标志物作一综述。     

不同类型新生儿败血症的临床分析

目的：研究不同类型新生儿败血症的临床特点,指导临床治疗。方法选择确诊为新生儿败血症的121例患儿,根据发病时间将其分为早发型败血症（生后72 h内）和晚发型败血症（出生72 h后）。分析比较早发型和晚发型败血症患儿的临床特点。结果121例新生儿败血症中,早发型35例（28.9％）,晚发型86例（71.1％）。早发型败血症多发生于足月儿（51.4％）,晚发型败血症多发生于早产儿（88.4％）和低出生体质量儿（87.2％）,两者比较差异具统计学意义（P＜0.05）。晚发型败血症患儿发生腹胀或喂养不耐受（72.1％）、反应欠佳（57.0％）及合并化脓性脑膜炎（37.2％）比例大于早发型（相应为34.3％、31.4％、17.1％）,两者比较差异具统计学意义（P＜0.05）。早发型败血症患儿血小板计数减低比例（62.9％）较晚发型（29.1％）高（P＜0.05）,两者比较差异具统计学意义（P＜0.05）。早发型败血症的主要致病菌是大肠埃希菌和肺炎克雷伯菌,晚发型败血症的主要致病菌是凝固酶阴性葡萄球菌。结论早发型败血症多发生于足月儿,晚发型败血症多发生于早产儿和低出生体质量儿,两种败血症的临床表现存在一定的差异,应结合不同类型的特点进行治疗。     

Biomarkers of sepsis: clinically useful?

PURPOSE OF REVIEW: The purpose of this review is to indicate recent developments in biomarkers of sepsis and to evaluate their impact on clinical use. According to the 'surviving sepsis campaign,' diagnosis of sepsis and infection is urgent; early and specific treatment is most effective to reduce complications and to decrease mortality. RECENT FINDINGS: A variety of biomarkers of sepsis is presently available. The diagnostic spectrum of the various markers, however, is different. Some primarily indicate severity of inflammation (e.g. interleukin-6), others respond to infection, but do not indicate the host response well (endotoxin, lipoprotein binding protein, triggering receptor on myeloid cells). There are new markers with limited clinical experience, for example triggering receptor on myeloid cells or mid-pro atrial natriuretic peptide (Seristra, Brahms AG, Hennigsdorf, Germany). Procalcitonin is a well-established biomarker of sepsis that fulfills several criteria of clinical needs: it responds both to infection and severity of inflammation and thus has an impact on therapy. Recent studies indicate that antibiotic treatment can also be guided by procalcitonin. Further indications, including diagnosis of invasive bacterial infections and diagnosis of sepsis in neonates and children have been reported recently. SUMMARY: Recent data and cumulative analyses indicate that biomarkers of sepsis improve diagnosis of sepsis. However, only a few markers have impact on therapy and fulfill the clinical requirements. Procalcitonin is a well-established marker, indicating infection, sepsis, and progression to the more severe stages of the disease. Today, this biomarker should be in the diagnostic portfolio of an intensive care unit or emergency ward.     

The electrocardiogram for sepsis: how close are we?

In daily clinical practice the diagnosis of sepsis is imprecise and often delayed. In part, this is because the diagnosis is based on a clinical picture of signs and symptoms. This basis has significant implications, as there is evidence that early events in sepsis may determine outcome. A more objective set of measurements for confirming the diagnosis of sepsis has long been sought. Several sepsis biomarkers have been evaluated and shown to have a moderate degree of sensitivity and specificity for diagnosing the presence of bacterial infection. Efforts are now being directed toward evaluating the utility of biomarker profiles, containing multiple markers, for risk assessment and diagnosis in patients with suspected sepsis.     

脓毒症休克的诊治在精准医学时代下的发展及临床应用

脓毒症休克病情凶险，致死率高。精准医学作为新型医学概念，其医疗模式影响了众多肿瘤及慢性病患者，也为脓毒症的精确诊治带来曙光。同时临床操作技术、基因检测、分子生物学的发展为脓毒症的精准诊治提供了数据和信息，通过对脓毒症患者不同病理生理状态、生物标志物、病原学、基因组学的分析与鉴定来进行个性化精准诊治。本文就精准医学在脓毒症休克诊治中取得的进展进行综述，并对这种新医疗模式的未来进行展望。