The Gut as the Motor of Multiple Organ Dysfunction in Critical Illness.
The Gut as the Motor of Multiple Organ Dysfunction in Critical Illness.
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肠道作为危重病多器官功能障碍的动力。
DOI：
10.1016/j.ccc.2015.11.004
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发表时间：
2016-04
影响因子：
4.3
通讯作者：
Coopersmith CM
中科院分区：
文献类型：
--
作者：
Klingensmith NJ;Coopersmith CM
肠道的所有组成部分——上皮、免疫系统和微生物群——都会受到重症的影响，并反过来传播导致多器官功能障碍综合征的病理性宿主反应。临床前研究表明，这可能是由于有毒的肠道来源物质释放到肠系膜淋巴中，造成远处损伤。此外，在危重疾病中，肠道完整性受到损害，细胞凋亡和通透性增加。人们也越来越多地认识到，微生物会根据宿主的环境线索改变它们的行为，并变得具有毒性。肠道衰竭在危重患者中很常见；然而，针对肠道的治疗方法已被证明在床边实施具有挑战性。最近在ICU中使用了许多策略来操纵微生物组，并取得了不同的成功。
All elements of the gut – the epithelium, the immune system, and the microbiome – are impacted by critical illness and can, in turn, propagate a pathologic host response leading to multiple organ dysfunction syndrome. Preclinical studies have demonstrated that this can occur by release of toxic gut-derived substances into the mesenteric lymph where they can cause distant damage. Further, intestinal integrity is compromised in critical illness with increases in apoptosis and permeability. There is also increasing recognition that microbes alter their behavior and can become virulent based upon host environmental cues. Gut failure is common in critically ill patients; however, therapeutics targeting the gut have proven to be challenging to implement at the bedside. Numerous strategies to manipulate the microbiome have recently been used with varying success in the ICU.