Update in Sepsis 2012
Update in Sepsis 2012
复制标题
DOI：
10.1164/rccm.201303-0567up
复制
发表时间：
2013-06-15
影响因子：
24.7
通讯作者：
Walley, Keith R.
中科院分区：
文献类型：
--
作者：
Russell, James A.;Walley, Keith R.
对2012年关键的脓毒症临床试验和临床前研究进行综述。对于从合成复杂淀粉溶液到重组人活化蛋白C的干预措施，大型多中心随机对照试验通常没有显示出益处，有些甚至在干预组显示了危害。在较小的创新临床试验中，简单的干预措施，如控制发烧的外部降温和生物标记物引导的机械通气脱机，发现了潜在的好处。败血症的生物标记物，包括多标记物组合，越来越显示出临床应用的前景。脓毒症基础研究的突破继续凸显全身炎症反应及其后果的复杂性。AJRCCM上的一系列文章跟踪了脓毒症的炎症反应，从细胞内结构和细胞器到线粒体和细胞骨架。其他出版物探讨了关键的白细胞亚群在脓毒症中的作用，强调了辅助性T细胞2型相关通路的作用被低估。微粒形式的细胞残留物会导致凝血障碍和进一步的器官功能障碍。因此，我们认为败血症可能是一种典型的疾病或状况，需要个性化护理，首先是为了发现和验证新的治疗方法，其次是为了提高存活率。
Pivotal sepsis clinical trials and preclinical research in 2012 are reviewed. For interventions ranging from synthetic complex starch solutions to recombinant human activated protein C, large multicenter randomized controlled trials generally failed to show benefit and some even demonstrated harm in the intervention group. In smaller innovative clinical trials simple interventions such as external cooling to control fever and biomarker-guided weaning from mechanical ventilation found potential benefit. Biomarkers for sepsis, including multimarker panels, are increasingly showing promise for clinical application. Breakthroughs in basic research in sepsis continue to highlight the complexity of the systemic inflammatory response and its consequences. A series of publications in AJRCCM follow the septic inflammatory response starting from intracellular structures and organelles to mitochondria and the cytoskeleton. Additional publications explore the key leukocyte subsets acting in sepsis, highlighting the underappreciated role of helper T-cell type 2-related pathways. Cellular remnants in the form of microparticles contribute to coagulopathy and further organ dysfunction. As a consequence, we suggest that sepsis may be the paradigm disease or condition requiring personalized care first to discover and validate new therapies and second to increase survival.