Role of the endothelium in viral hemorrhagic fevers
Role of the endothelium in viral hemorrhagic fevers
复制标题
DOI：
10.1097/00003246-200205001-00016
复制
发表时间：
2002-05-01
影响因子：
8.8
通讯作者：
Zaki, SR
中科院分区：
文献类型：
--
作者：
Peters, CJ;Zaki, SR
目的：描述内皮细胞参与病毒性出血热和某些其他急性传染病的发病机制。数据提取和合成：调查发表的文献中的病毒性出血热解释在病人的观察和研究，这些diseases.Conclusions：内皮细胞参与是一个非常重要的因素，在临床综合征称为病毒性出血热。内皮功能障碍在出血的发生中是重要的，出血并不普遍，通常仅在血小板减少症或严重血小板功能障碍的情况下出现。内皮功能障碍的发病机制在不同的疾病中是不同的。在某些情况下，直接内皮感染在增加血管通透性、改变促凝血剂与抗凝剂平衡或细胞因子产生方面是重要的。在迄今为止研究的所有病毒性出血热中，细胞因子诱导是一个重要因素，也作用于内皮。心肌收缩力差是病毒性出血热的一个非常重要的问题，不是由心脏的直接病毒感染引起的;越来越多的人认识到，这些患者表现为低心输出量和高外周阻力，并且他们对液体输注的反应很差。病毒性出血热的临床表现不同于脓毒症综合征，应单独研究和解释;这种方法将使治疗方法更加尖锐，并能阐明脓毒症的一般问题。
Objective: To describe endothelial participation in the pathogenesis of viral hemorrhagic fevers and certain other acute infectious diseases.Data Extraction and Synthesis: Survey of published literature on viral hemorrhagic fevers Interpreted in light of observations in patients and research on those diseases.Conclusions: Endothelial involvement is an extremely important factor In the clinical syndrome termed viral hemorrhagic fever. Endothelial dysfunction is important In the genesis of bleeding, which is not universal and is commonly seen only in the presence of thrombocytopenia or severe platelet dysfunction. The pathogenesis of endothelial dysfunction varies In the different diseases. In some situations, direct endothelial infection Is important in increased vascular permeability, changes in the procoagulant vs. anticoagulant balance, or cytokine production. In all the viral hemorrhagic fevers studied to date, cytokine induction is an Important factor and also acts on the endothelium. Poor myocardial contractility is a very important issue in viral hemorrhagic fever and is not caused by direct viral infection of the heart; it is increasingly being recognized that these patients present with low cardiac output and high peripheral resistance and that they respond poorly to fluid infusion. The clinical findings in viral hemorrhagic fever differ from those In the sepsis syndrome and should be studied and interpreted separately; this approach will sharpen therapeutic approaches and could shed light on the problems of sepsis in general.