Immunological monitoring to prevent and treat sepsis.
Immunological monitoring to prevent and treat sepsis.
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DOI：
10.1186/cc11922
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发表时间：
2013-01-25
期刊：
影响因子：
--
通讯作者：
Bermejo-Martin JF
中科院分区：
文献类型：
--
作者：
Almansa R;Wain J;Tamayo E;Andaluz-Ojeda D;Martin-Loeches I;Ramirez P;Bermejo-Martin JF
与脓毒症相关的临床、人力和经济负担是巨大的。诸如败血症幸存运动之类的倡议旨在有效降低严重败血症和败血症休克的死亡风险。尽管如此，虽然这项运动的实施取得了很大的好处，但如果我们要实现这一战略所承诺的全部潜力，还有很多工作要做。在我们设计一套有效的干预措施之前，有必要对导致脓毒症的过程有更深入的了解。对感染的免疫反应失调被认为是该病的发病机制之一。从确诊后的第一个小时就可以观察到促炎症和免疫抑制细胞因子的产生。此外，感染性休克患者常出现低丙种球蛋白血症。此外，确诊时的免疫球蛋白、免疫球蛋白M和免疫球蛋白A水平与存活率直接相关。反过来，死亡者的C4(补体系统的一种蛋白质)水平低于幸存者。自然杀伤细胞的数量和功能似乎在这种疾病中也起着重要作用。单核细胞表面的HLA-DR和血液中的CD4+CD25+T-调节细胞计数也可能是脓毒症的有用生物标志物。在基因组水平上，在感染性休克中观察到与主要组织相容性复合体抗原提呈相对应的网络的抑制。因此，累积的证据支持免疫监测的潜在作用，以指导以个性化和及时的方式预防或治疗败血症的措施(早期给予抗生素、免疫球蛋白替代、免疫调节)。总而言之，尽管目前的信息弥漫和有限，但现有的信息支持开展大型综合研究，旨在紧急评估免疫监测作为预防脓毒症的工具，指导其治疗，从而减少与这一严重疾病相关的发病率和死亡率。
The clinical, human and economic burden associated with sepsis is huge. Initiatives such as the Surviving Sepsis Campaign aim to effectively reduce risk of death from severe sepsis and septic shock. Nonetheless, although substantial benefits raised from the implementation of this campaign have been obtained, much work remains if we are to realise the full potential promised by this strategy. A deeper understanding of the processes leading to sepsis is necessary before we can design an effective suite of interventions. Dysregulation of the immune response to infection is acknowledged to contribute to the pathogenesis of the disease. Production of both proinflammatory and immunosuppressive cytokines is observed from the very first hours following diagnosis. In addition, hypogammaglobulinemia is often present in patients with septic shock. Moreover, levels of IgG, IgM and IgA at diagnosis correlate directly with survival. In turn, nonsurvivors have lower levels of C4 (a protein of the complement system) than the survivors. Natural killer cell counts and function also seem to have an important role in this disease. HLA-DR in the surface of monocytes and counts of CD4+CD25+ T-regulatory cells in blood could also be useful biomarkers for sepsis. At the genomic level, repression of networks corresponding to major histocompatibility complex antigen presentation is observed in septic shock. In consequence, cumulative evidence supports the potential role of immunological monitoring to guide measures to prevent or treat sepsis in a personalised and timely manner (early antibiotic administration, immunoglobulin replacement, immunomodulation). In conclusion, although diffuse and limited, current available information supports the development of large comprehensive studies aimed to urgently evaluate immunological monitoring as a tool to prevent sepsis, guide its treatment and, as a consequence, diminish the morbidity and mortality associated with this severe condition.
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影响因子：
3.8
作者：
Andaluz-Ojeda, David;Bobillo, Felipe;Bermejo-Martin, Jesus F.
通讯作者：
Bermejo-Martin, Jesus F.
影响因子：
38.9
作者：
Levy, Mitchell M.;Dellinger, R. Phillip;Angus, Derek C.
通讯作者：
Angus, Derek C.
影响因子：
2.8
作者：
Tamayo, Eduardo;Fernandez, Ana;Bermejo-Martin, Jesus F.
通讯作者：
Bermejo-Martin, Jesus F.
影响因子：
2.9
作者：
Monneret, Guillaume;Venet, Fabienne;Netea, Mihai G.
通讯作者：
Netea, Mihai G.
DOI：
10.1164/rccm.201204-0645oc
发表时间：
2012-11-01
影响因子：
24.7
作者：
Leentjens, Jenneke;Kox, Matthijs;Pickkers, Peter
通讯作者：
Pickkers, Peter