Patients After Splenectomy: Old Risks and New Perspectives
Patients After Splenectomy: Old Risks and New Perspectives
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DOI：
10.21614/chirurgia.111.5.393
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发表时间：
2016-09-01
期刊：
影响因子：
0.6
通讯作者：
Vasilescu, Catalin
中科院分区：
文献类型：
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作者：
Dragomir, Mihnea;Petrescu, George Emil Dragos;Vasilescu, Catalin
脾切除术后出现的风险可分为感染性和非感染性。脾切除术和这些危险之间的联系仍然部分未知。脾切除术后宿主对感染的防御发生改变，这些个体更容易发展为脓毒症，感染具有暴发性过程。脾切除术也是由动脉或静脉血管的部分或全部阻塞引起的几种血管并发症的潜在危险因素。此外，肺动脉高压可能是脾切除术后的严重并发症，有时甚至是致命的。也有人认为恶性肿瘤、糖尿病、急性胰腺炎是脾切除术后的非感染性并发症。脾切除患者最担心的并发症仍然是败血症。脓毒症的病理生理机制仍有争议。败血症中的死亡可由于过度炎症或“免疫麻痹”而发生。多种实验证据将细胞和病毒microRNA与脓毒症联系起来。我们推测miRNAs也与无脾患者的免疫抑制有关，这导致致命败血症的高风险。研究无脾患者外周血循环中miRNAs的表达水平有助于我们更好地理解脾切除术后免疫抑制的机制，并有助于开发新的诊断和治疗工具。
The risks that arise after splenectomy can be divided in infectious and non-infectious. The link between splenectomy and these hazards remains partially unknown. Host defense against infection is altered after splenectomy and such individuals develop sepsis more easily and the infection has a fulminant course. Splenectomy is also a potential risk factor for several vascular complications that result from partial or total obstruction of an arterial or venous blood vessel. Furthermore, pulmonary hypertensioncan be a severe and sometimes fatal complication following splenectomy. Some authors also consider that malignancies, diabetes mellitus and acute pancreatitis are non-infectious complications after splenectomy. The most feared complication for splenectomized patients remains sepsis. The pathophysiology of sepsis is still controversial. Death in sepsis can occur due to either hyper-inflammation or "immune paralysis". Multiple experimental evidences link cellular and viral microRNAs with sepsis. We presume that miRNAs are also associated with the immunosuppression of the asplenic patients which leads to the high risk of deadly sepsis. Studying the expression level of circulating miRNAs in asplenic patients could help us better understand the post-splenectomy immunosuppression and develop new diagnostic and therapeutic tools.