Pathophysiology of sepsis-related cardiac dysfunction: driven by inflammation, energy mismanagement, or both?
Pathophysiology of sepsis-related cardiac dysfunction: driven by inflammation, energy mismanagement, or both?
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DOI：
10.1007/s11897-014-0247-z
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发表时间：
2015-04
影响因子：
--
通讯作者：
Goldberg, Ira J
中科院分区：
文献类型：
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作者：
Drosatos, Konstantinos;Lymperopoulos, Anastasios;Kennel, Peter Johannes;Pollak, Nina;Schulze, P Christian;Goldberg, Ira J
脓毒症是细菌感染后的全身炎症反应。心功能障碍是脓毒症的重要后果，影响死亡率，并已归因于炎症升高或脂肪酸和葡萄糖氧化抑制以及最终ATP耗竭。此外，心脏肾上腺素能信号传导在脓毒症患者中受损，这进一步损害了心脏功能。虽然抗炎治疗对于疾病的治疗很重要，但抗炎药物的施用并不能改善脓毒症患者的存活率。这篇综述文章总结了脓毒症引发的炎症和其他机制的研究结果，并影响心脏功能和死亡率。特别是，它侧重于疾病在代谢途径中的影响，以及肾上腺素能信号传导和后者与炎症的潜在相互作用。建议治疗方法应包括抗炎治疗、刺激能量产生和恢复心脏中的肾上腺素能信号的组合。
Sepsis is a systemic inflammatory response that follows bacterial infection. Cardiac dysfunction is an important consequence of sepsis that affects mortality and has been attributed to either elevated inflammation or suppression of both fatty acid and glucose oxidation and eventual ATP depletion. Moreover, cardiac adrenergic signaling is compromised in septic patients and this aggravates further heart function. While anti-inflammatory therapies are important for the treatment of the disease, administration of anti-inflammatory drugs did not improve survival in septic patients. This review article summarizes findings on inflammatory and other mechanisms that are triggered in sepsis and affect cardiac function and mortality. Particularly, it focuses on the effects of the disease in metabolic pathways, as well as in adrenergic signaling and the potential interplay of the latter with inflammation. It is suggested that therapeutic approaches should include combination of anti-inflammatory treatments, stimulation of energy production, and restoration of adrenergic signaling in the heart.