Endocrine Responses to Critical Illness: Novel Insights and Therapeutic Implications
Endocrine Responses to Critical Illness: Novel Insights and Therapeutic Implications
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DOI：
10.1210/jc.2013-4115
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发表时间：
2014-05-01
影响因子：
5.8
通讯作者：
Van den Berghe, Greet
中科院分区：
文献类型：
--
作者：
Boonen, Eva;Van den Berghe, Greet
背景：危重病是严重身体压力的一种极端形式，其特征是重要的内分泌和代谢变化。由于重症监护医学，从以前的致命条件下生存已经成为可能，但许多患者现在进入慢性期的危重病。内分泌和代谢反应的作用，急性和长期的危重病在调解或阻碍recovery.Evidence收购：最近的文献中的变化下丘脑-垂体-甲状腺轴和下丘脑-垂体-肾上腺轴和高血糖症的关系，从危重病的恢复进行了严格的评价和解释对以前的见解。可能的治疗意义的新的见解进行了分析。具体剩余的问题制定。证据合成：近年来，重要的新见解的病理生理学和后果的一些内分泌反应的急性和慢性危重病产生。急性内分泌适应是指在外源性底物剥夺的情况下，为重要的战斗或逃跑反应提供能量和底物。不同的内分泌和代谢改变的特点慢性阶段的危重病，这似乎不再是唯一有益的，可能会妨碍恢复和rehabilitation.Conclusions：重要的新见解重塑目前的观点对危重病的内分泌和代谢反应，并进一步澄清潜在的途径。虽然许多问题尚未解决，但已经确定了一些治疗意义。需要做更多的工作来找到更好的治疗方法，以及这种治疗的最佳时机，以进一步预防长期严重疾病，促进其恢复，并优化康复。
Context: Critical illness, an extreme form of severe physical stress, is characterized by important endocrine and metabolic changes. Due to critical care medicine, survival from previously lethal conditions has become possible, but many patients now enter a chronic phase of critical illness. The role of the endocrine and metabolic responses to acute and prolonged critical illness in mediating or hampering recovery remains highly debated.Evidence Acquisition: The recent literature on changes within the hypothalamic-pituitary-thyroid axis and the hypothalamic-pituitary-adrenal axis and on hyperglycemia in relation to recovery from critical illness was critically appraised and interpreted against previous insights. Possible therapeutic implications of the novel insights were analyzed. Specific remaining questions were formulated.Evidence Synthesis: In recent years, important novel insights in the pathophysiology and the consequences of some of these endocrine responses to acute and chronic critical illness were generated. Acute endocrine adaptations are directed toward providing energy and substrates for the vital fight-or-flight response in a context of exogenous substrate deprivation. Distinct endocrine and metabolic alterations characterize the chronic phase of critical illness, which seems to be no longer solely beneficial and could hamper recovery and rehabilitation.Conclusions: Important novel insights reshape the current view on endocrine and metabolic responses to critical illness and further clarify underlying pathways. Although many issues remain unresolved, some therapeutic implications were already identified. More work is required to find better treatments, and the optimal timing for such treatments, to further prevent protracted critical illness, to enhance recovery thereof, and to optimize rehabilitation.