肠道功能损害还是脓毒症的“发动机”吗?  

Is gut dysfunction still the'motor'of sepsis?

作　　者：吉晶晶 刘喆滢 苏磊 刘志锋 Ji Jingjing;Liu Zheying;Su Lei;Liu Zhifeng(Graduate School,Southern Medical University,Guangzhou 510515,China;Department of Critical Care Medicine,General Hospital of Southern Theatre Command of Chinese PLA,Guangzhou 510010,China)

机构地区：[1]南方医科大学研究生院,广州510515 [2]南部战区总医院重症医学科,广州510010

出　　处：《中华重症医学电子杂志》2020年第3期267-271,共5页Chinese Journal Of Critical Care & Intensive Care Medicine(Electronic Edition)

基　　金：国家自然科学基金(81571940,81741125);军队后勤医学科研项目(CWH17L020,17CXZ008,18CXZ030)。

摘　　要：脓毒症是由于感染导致宿主免疫失调反应而导致脏器功能衰竭的一组临床综合征,具有高发病率、高病死率、高治疗费用的特点。脓毒症状态下,肠道上皮细胞凋亡增加、通透性增加、黏膜完整性破坏以及肠道内菌群失衡,促进了脓毒症的进展,因而被称为脓毒症的“发动机”。近年来,随着研究的不断深入,肠道损害在脓毒症和多脏器功能障碍中的关键作用一直受到争议。笔者结合最新研究,对该理论体系进行分析总结,以期用新的依据回答该问题,即肠道损害还是脓毒症的“发动机”吗?分析发现,尽管细菌移位理论假说已不被试验结果支持,但肠道损害仍是脓毒症进展的重要驱动力,其因素包括:肠源性毒性淋巴液、上皮细胞凋亡和通透性增加、肠道内微生物菌群等。Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection,with high morbidity,mortality,and cost.Under the sepsis state,many gut factors,including increased cell apoptosis and permeability,mucosal damage,and flora imbalance,could promote the process of sepsis.Therefore,gut dysfunction was previously regarded as the'motor'of sepsis.However,some new studies posed a challenge on the key role of gut dysfunction in sepsis.In this paper,we summarize new studies to answer the question whether gut dysfunction is still the'motor'of sepsis.The results obtained from these studies show that even the bacterial translocation theory is unsupported by the new studies,gut dysfunction is still the important driver of the process of sepsis.Severe diseases could induce gut dysfunction by increasing epithelial apoptosis,gut permeability,and chemical and immune barrier damage.Meanwhile,flora imbalance is also one of the factors that promote multi-organ dysfunction.In conclusion,gut dysfunction is still the'motor'of sepsis and can promote the process of sepsis.

关 键 词：脓毒症 肠道损害 多器官功能障碍综合征 

分 类 号：R459.7[医药卫生—急诊医学]