Scientific and clinical challenges in sepsis.
Scientific and clinical challenges in sepsis.
复制标题
DOI：
10.2174/138161209788453248
复制
发表时间：
2009
影响因子：
3.1
通讯作者：
Deitch EA
中科院分区：
文献类型：
--
作者：
Ulloa L;Brunner M;Ramos L;Deitch EA
重症监护和抗生素的进步阻止了一些感染的传播，但败血症死亡率仍然很高。随着三十多项临床试验的失败，脓毒症仍然是现代医学的科学和临床挑战。脓毒症的定义是对感染的全身炎症反应的临床体征。“严重脓毒症”是指这些症状与多器官功能障碍有关。这些脓毒症的定义可能过于宽泛，对于不一定患有相同疾病的异质性患者群体来说过于常见。这种考虑在临床试验中变得特别明显，这些临床试验在诊断为严重脓毒症的患者的类似研究中未能获得一致的结果。在这些试验中，患有由不同微生物引起的感染并影响不同器官的患者在严重脓毒症的一般诊断下合并。这种情况类似于试图根据癌症的一般定义进行临床试验，将所有患有肿瘤的患者与恶性肿瘤的类型相结合。考虑到这一点，活化蛋白C（美国食品和药物管理局批准的唯一治疗败血症的药物）预计仅用于一小部分严重败血症患者也就不足为奇了。本文综述了新的炎症分子方面和实验性抗炎策略脓毒症，因为他们可能代表特定的病理过程中的特定子集的患者。
Advances in intensive care and antibiotics have prevented the spread of some infections, though sepsis mortality rates remain high. With failure of over thirty clinical trials, sepsis remains a scientific and clinical challenge in modern medicine. Sepsis is defined by the clinical signs of a systemic inflammatory response to infection. “Severe sepsis” is when these symptoms are associated with multiple organ dysfunction. These definitions of sepsis may be too broad and common to heterogeneous groups of patients who do not necessarily have the same disorder. This consideration has become especially evident in the clinical trials that have failed to obtain consistent results in similar studies of patients diagnosed with severe sepsis. In these trials, patients with infections caused by different microorganisms, and affecting different organs, have been combined under the general diagnosis of severe sepsis. The situation is analogous to attempting a clinical trial based on the general definition of cancer, combining all patients with tumor independent of the type of malignancy. In this consideration, it would not be very surprising that activated protein C, the only treatment in sepsis approved by the Food and Drug Administration, is projected for use in only a small subset of patients with severe sepsis. This article reviews novel inflammatory molecular aspects and the experimental anti-inflammatory strategies for sepsis, as they may represent particular pathological processes in specific subsets of patients.
登录
查看更多内容
DOI：
10.1152/ajplung.00491.2007
发表时间：
2009-03-01
影响因子：
4.9
作者：
Barlos, Dimtrios;Deitch, Edwin A.;Feinman, Rena
通讯作者：
Feinman, Rena
影响因子：
158.5
作者：
BONE, RC;FISHER, CJ;BALK, RA
通讯作者：
BALK, RA
影响因子：
82.9
作者：
Calandra, T;Echtenacher, B;Glauser, MP
通讯作者：
Glauser, MP
影响因子：
8.8
作者：
Abraham, E;Matthay, MA;Repine, JE
通讯作者：
Repine, JE
巨噬细胞是巨噬细胞迁移抑制因子的重要且以前未被认可的来源。
影响因子：
15.3
作者：
Calandra, Thierry;Bernhagen, Juergen;Mitchell, Robert A.;Bucala, Richard
通讯作者：
Bucala, Richard