Therapeutic implications of immunoparalysis in critically ill patients
Therapeutic implications of immunoparalysis in critically ill patients
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DOI：
10.2174/187152807783334337
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发表时间：
2007-12-01
期刊：
影响因子：
--
通讯作者：
Taboada, Francisco
中科院分区：
文献类型：
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作者：
Albaiceta, Guillermo M.;Pedreira, Paula R.;Taboada, Francisco
与全身炎症反应的经典观点相反，越来越多的证据表明，在危重病期间，存在旨在避免局部促炎反应扩散的全身炎症状态。由此产生的免疫抑制增加了医院感染的风险，并与危重患者发病率和死亡率的增加有关。单核细胞在协调炎症反应中起关键作用，并且该群体的功能障碍是这些现象的原因。主要组织相容性复合物的II类分子的表面表达降低既是这种状态的标志物，也是一种发病机制，因为它降低了单核吞噬细胞的抗原呈递能力。有一些治疗策略来克服这种情况。像IFN γ或GM-CSF这样的细胞因子已经在动物模型和患者中进行了测试，但没有结论性的数据。其他药物如Flt 3、AS 101或IL-10抗体仅在实验模型中进行了测试。发展一个新的框架，炎症反应，需要一个共识，在免疫监测和实验和临床试验的发展，以改善严重患者的全身损伤的结果。
In opposite to the classic view of the systemic inflammatory response, there is increasing evidence that, during critical illness, there is a systemic antiinflammatory state intended to avoid the spread of the local proinflammatory response. The resulting immunosupression increases the risk of nosocomial infections, and has been related to an increase in morbidity and mortality in critically ill patients. Monocytes play a key role in orchestrating the inflammatory response, and a functional impairment of this population is the responsible for these phenomena. The decreased surface expression of class II molecules of the Main Histocompatibility Complex is both a marker of this state and a pathogenetic mechanism, as it decreases the antigen presentation capabilities of the mononuclear phagocytes. There are some therapeutic strategies to overcome this situation. Cytokines like IFN gamma or GM-CSF have been tested in animal models and patients, but there are no conclusive data. Other drugs like Flt3, AS101 or antibodies against IL-10 have been tested only in experimental models. The development of a new framework on the inflammatory response, the need for a consensus in immune monitoring and the development of experimental and clinical trials are required to improve the outcome of severe patients with systemic injuries.