Pathogenesis of infection in surgical patients.
Pathogenesis of infection in surgical patients.
复制标题
手术患者感染的发病机制
DOI：
10.1097/mcc.0000000000000227
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发表时间：
2015-08
影响因子：
3.3
通讯作者：
Fang X
中科院分区：
文献类型：
--
作者：
Cui P;Fang X
尽管预防性抗菌治疗和先进技术的应用，感染仍然是外科患者发病和死亡的最常见原因之一。了解外科感染的发病机制将为生物标志物的发展提供新的见解，以预测和分层患者的感染，并探索具体的策略，以尽量减少这种严重的术后并发症。最近的发现：由手术损伤引起的内源性危险信号触发的急性非特异性炎症反应是有益的，但矛盾的是与感染抵抗力降低有关。越来越多的证据表明，手术损伤引发的炎症会加剧术后对病原体入侵的免疫炎症反应的失调。先天免疫受体，如Toll样受体（TLR），有助于检测病原体相关的分子模式和内源性损伤相关的分子模式，并进一步放大对感染的炎症反应。目前的证据表明非TLR在感染过程中的迷人作用。非TLR，如髓样细胞家族表达的膜相关触发受体、胞质核苷酸结合寡聚化结构域样受体和核受体核家族4亚群A受体，在触发免疫应答和建立有效防御手术损伤和感染的二次打击中也是至关重要的。了解非TLRs在感受外源性和内源性分子中的关键作用，以及引发的全身性炎症和免疫状态低下对手术损伤后抵抗病原体的影响，将有助于充分探索手术感染的相关复杂现象，并阐明这一特殊人群中临床体征和症状的异质性。
Purpose of reviewDespite the application of prophylactic antimicrobial therapy and advanced technologies, infection remains one of the most common causes of morbidity and mortality in surgical patients. Understanding the pathogenesis of surgical infection would offer new insights into the development of biomarkers to predict and stratify infection in patients, and to explore specific strategies to minimize this serious postoperative complication. Recent findingsThe acute nonspecific inflammatory response triggered by endogenous danger signals evoked by surgical insult is beneficial, while paradoxically associated with reduced resistance to infection. There is growing evidence indicating that primed inflammation by surgical insult exaggerates the dysregulation of the immune-inflammatory response to the invasion of pathogens postoperatively. Innate immune receptors, such as Toll-like receptors (TLRs), contribute to detecting both pathogen-associated molecular patterns and endogenous damage-associated molecular patterns, and to further amplifying inflammatory responses to infection. Current evidence shows the fascinating role of non-TLRs in the process of infection. Non-TLRs, such as membrane-associated triggering receptor expressed on myeloid cells family, cytosolic nucleotide-binding oligomerization domain-like receptors and nuclear receptor nuclear family 4 subgroup A receptors, are also crucial in triggering the immune responses and mounting an effective defense against surgical insults and the second hit of infection. SummaryUnderstanding the pivotal role of non-TLRs in sensing exogenous and endogenous molecules, and the influence of primed systemic inflammation and depressed immune status on the defense against pathogen after surgical insult, would be helpful to fully explore the relevant sophisticated phenomena of surgical infection, and to elucidate the occurrence of heterogeneous constellations of clinical signs and symptoms among this special population.