脓毒症的过度炎症反应与免疫抑制  

Hyper-inflammatory response and immunosuppression in sepsis

作　　者：马跃 傅斌清[1] 魏海明[1] Ma Yue;Fu Binqing;Wei Haiming(Institue of Immunology,Department of Life Sciences and Medicine,University of Science and Technology of China,Hefei 230027,China)

机构地区：[1]中国科学技术大学免疫学研究所/生命科学与医学部,合肥230027

出　　处：《中华微生物学和免疫学杂志》2025年第3期190-197,共8页Chinese Journal of Microbiology and Immunology

基　　金：中国科学院基础与交叉前沿科研先导专项(XDB0490000)。

摘　　要：脓毒症被定义为由宿主对感染的反应失调引起的危及生命的器官功能障碍综合征,在全世界广泛发生且具极高病死率。本文回顾了对脓毒症免疫学特征认识的发展过程,指出了脓毒症发展进程中促炎和抑炎反应的同时发生,即疾病早期促炎状态占主导,表现为细胞因子风暴和血管损伤,而疾病后期抑炎状态占主导,表现为免疫抑制和继发感染,并且分别阐述了这两种反应的免疫学特征,包括炎症风暴与凝血紊乱的相互推动、免疫细胞的死亡与耗竭等。脓毒症靶向治疗的障碍来源于其异质性,区分脓毒症患者的不同亚型、描绘各亚型免疫学特征与致病机制,从而对某一可划分亚型进行集中攻关是未来脓毒症免疫诊疗发展的重要方向。Sepsis is defined as a life-threatening organ dysfunction caused by a dysregulated host response to an infection.It is a high-mortality syndrome that is widespread globally.In this review,we explore the evolving understanding of the immunological features of sepsis,emphasizing the simultaneous occurrence of pro-inflammatory and anti-inflammatory responses during the disease progression.Early in the disease course,the host is typically in a pro-inflammatory state,characterized by excessive inflammatory responses and vascular damage.As the disease progresses,the host tends toward an immunosuppressive state,marked by immune suppression and secondary infections.This article outlines the immunological characteristics of these two states,including the reciprocal promotion of inflammatory storms and coagulation abnormalities,as well as the death and depletion of immune cells.The heterogeneity of sepsis presents a significant challenge to targeted therapy.A key future direction in sepsis immunology diagnosis and treatment is distinguishing endotypes among sepsis patients,identifying the immunological features and pathogenic mechanisms of each endotype,and enabling focused therapeutic interventions targeting specific sepsis endotypes.

关 键 词：脓毒症 炎症反应 细胞因子风暴 免疫抑制 

分 类 号：R459.7[医药卫生—急诊医学]