Mechanisms of sepsis-induced organ dysfunction
Mechanisms of sepsis-induced organ dysfunction
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DOI：
10.1097/01.ccm.0000282072.56245.91
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发表时间：
2007-10-01
影响因子：
8.8
通讯作者：
Singer, Mervyn
中科院分区：
文献类型：
--
作者：
Abraham, Edward;Singer, Mervyn
背景资料：在过去的几年里，在理解与脓毒症相关的器官功能障碍和恢复的基本细胞和生理机制方面取得了显着进展。虽然一些新的治疗方法已经改善了脓毒症患者的预后，但这些对脓毒症相关机制的新见解的深远潜力才刚刚开始实现。目的：2006年布鲁塞尔圆桌会议召集了炎症和脓毒症领域的30多位专家，回顾了脓毒症的最新进展，并讨论了该领域在不久的将来可能采取的方向。目前对脓毒症诱导的多器官功能障碍的病理生理学的理解强调了参与这种复杂状况的多个细胞群和细胞信号通路。越来越多的人认识到受脓毒症过程影响的不同细胞和器官之间存在的相互作用。由介质、激素、代谢物、神经信号传导、氧输送和利用的改变以及细胞表型的改变的时间变化提供的复杂的串扰强调了适应性甚至协调性过程，超越了曾经被认为是脓毒症的失调混乱。许多以前被认为是有害的病理过程现在被认为是潜在的保护。将系统方法应用于这些复杂的过程将允许更好地评价治疗的有效性或危害，无论是现在还是将来，并且还将允许开发不仅更好地指导，而且更适当地定时的策略，以改善这种仍然高度致命的情况的结果。
Background: The past several years have seen remarkable advances in understanding the basic cellular and physiologic mechanisms underlying organ dysfunction and recovery relating to sepsis. Although several new therapeutic approaches have improved outcome in septic patients, the far-reaching potential of these new insights into sepsis-associated mechanisms is only beginning to be realized.Aim: The Brussels Round Table Conference in 2006 convened >30 experts in the field of inflammation and sepsis to review recent advances involving sepsis and to discuss directions that the field is likely to take in the near future.Findings: Current understanding of the pathophysiology underlying sepsis-induced multiple organ dysfunction highlights the multiple cell populations and cell-signaling pathways involved in this complex condition. There is an increasing appreciation of interactions existing between different cells and organs affected by the septic process. The intricate cross-talk provided by temporal changes in mediators, hormones, metabolites, neural signaling, alterations in oxygen delivery and utilization, and by modifications in cell phenotypes underlines the adaptive and even coordinated processes beyond the dysregulated chaos in which sepsis was once perceived. Many pathologic processes previously considered to be detrimental are now viewed as potentially protective. Applying systems approaches to these complex processes will permit better appreciation of the effectiveness or harm of treatments, both present and future, and also will allow development not only of better directed, but also of more appropriately timed, strategies to improve outcomes from this still highly lethal condition.