脓毒症相关肝损伤中医药治疗思路

脓毒症是严重感染或创伤后常见的并发症,可造成多器官功能障碍,肝损伤是脓毒症常见的并发症,并且在脓毒症向多器官功能障碍的发展过程中作为一个非常重要的环节。脓毒症相关肝损伤的发病率较高,对脓毒症的预后具有特异性的预警作用,可以作为独立的危险因素。脓毒症相关肝损伤的发病机制,主要是炎性因子释放导致的肝细胞功能障碍,包括肝细胞的坏死和凋亡、再生障碍、微循环障碍、能量代谢障碍等。肝脏Kupffer细胞在肝细胞损害和肝功能障碍中具有重要的调控作用,肝星形细胞也参与了这一过程。脓毒症合并肝损伤主要表现为血清转氨酶和碱性磷酸酶的升高以及轻至中度高胆红素血症。脓毒症相关肝损伤属于中医学理论中热毒症的范畴,属于急黄。Kupffer细胞在发病机制中的重要作用,应该属于三焦的范畴,因此,清利三焦应该作为本病的重要治法。

Treatment Thoughts of Traditional Chinese Medicine in Sepsis Related Liver Injury

Sepsis is a common complications after serious infection or trauma, sepsis can cause multiple organ dysfunction. Liver injury is a common complication of sepsis, and play a very important link in the process of the development of multiple organ dysfunction. Sepsis related liver injury have higher incidence, is a characteristic early warning indicators for the prognosis of sepsis, can be used as an inde- pendent risk factor. In the pathogenesis of sepsis related liver damage is mainly caused by inflammatory cytokines released hepatocellular dysfunction, including liver cell necrosis and apoptosis, regeneration barrier, microcirculation, energy metabolic disorders, etc. Liver Kupffer cells plays an important regulatory role in the liver cell injury and liver dysfunction, hepatic stellate cells also involved in this process. Sepsis combined liver injury mainly show elevated serum aminotransferase and alkaline phosphatase, and mild to moderate high blood bilirubin. Sepsis related liver injury belongs to the category of disease of toxic heat in TCM theory, belong to the emergency and vio- lation of jaundice. Important role in the pathogenesis of Kupffer cells, belongs to the category of the sanjiao （triple energizer ） disease. Therefore,clear the sanjiao（ triple energizer）should be as an important treatment of the disease.