切换至 "中华医学电子期刊资源库"

中华危重症医学杂志(电子版) ›› 2024, Vol. 17 ›› Issue (03) : 245 -250. doi: 10.3877/cma.j.issn.1674-6880.2024.03.012

综述

糖皮质激素在病毒性脓毒症中的作用
余登辉1, 杜虹1, 姜泓1, 连建奇1,()   
  1. 1. 710038 西安,空军军医大学第二附属医院传染科
  • 收稿日期:2023-06-09 出版日期:2024-06-30
  • 通信作者: 连建奇
  • 基金资助:
    陕西省卫生健康科研基金项目(2022A011); 空军军医大学临床研究常规项目(2021LC2222); 空军军医大学第二附属医院科技创新发展基金临床研究重点项目(2019LCYJ002); 空军军医大学第二附属医院临床研究常规项目(2021LCYJ025)
  • Received:2023-06-09 Published:2024-06-30
引用本文:

余登辉, 杜虹, 姜泓, 连建奇. 糖皮质激素在病毒性脓毒症中的作用[J]. 中华危重症医学杂志(电子版), 2024, 17(03): 245-250.

Sepsis-3.0重新定义脓毒症为"宿主对感染反应失调导致的危及生命的器官功能障碍",其病原体包括细菌、真菌、病毒等[1]。细菌感染是脓毒症的主要原因,但是在儿童、免疫缺陷群体以及部分热带地区的脓毒症病例中,病毒感染占有较高的比例。东南亚的一项多中心、横断面研究对社区获得性脓毒症患者进行了多种病原体检测,结果显示在儿童和成人中,病毒性脓毒症分别占36%和12%,其中常见的病毒是登革病毒(dengue virus,DV)、鼻病毒、流感病毒等[2]。多种病毒可引起病毒性脓毒症,但其诊断率相对偏低,亦缺乏深入的研究。近年来埃博拉病毒病(Ebola virus disease,EVD)、新型冠状病毒感染(corona virus disease 2019,COVID-19)疫情促使越来越多的学者开始关注病毒性脓毒症。然而,病毒性脓毒症目前尚无一个明确的定义,儿科领域将其定义为对病毒感染的严重炎症反应[3],也有学者认为可以参照Sepsis-3.0对病毒性脓毒症进行定义和诊断[4-5]。糖皮质激素(glucocorticoid,GC)在感染中的应用已有70余年的历史,但其在感染性疾病中的治疗作用仍存在争议。本文将对GC在病毒性脓毒症中的作用进行综述。

1
Singer M, Deutschman CS, Seymour CW, et al. The third international consensus definitions for sepsis and septic shock (sepsis-3)[J]. JAMA, 2016, 315 (8): 801-810.
2
Southeast Asia Infectious Disease Clinical Research Network. Causes and outcomes of sepsis in southeast Asia: a multinational multicentre cross-sectional study[J]. Lancet Glob Health, 2017, 5 (2): e157-e167.
3
Gupta N, Richter R, Robert S, et al. Viral sepsis in children[J]. Front Pediatr, 2018 (6): 252.
4
Li H, Liu L, Zhang D, et al. SARS-CoV-2 and viral sepsis: observations and hypotheses[J]. Lancet, 2020, 395 (10235): 1517-1520.
5
Lin GL, McGinley JP, Drysdale SB, et al. Epidemiology and immune pathogenesis of viral sepsis[J]. Front Immunol, 2018 (9): 2147.
6
Dolin HH, Papadimos TJ, Chen X, et al. Characterization of pathogenic sepsis etiologies and patient profiles: a novel approach to triage and treatment[J]. Microbiol Insights, 2019 (12): 1178636118825081.
7
Li D, Wu M. Pattern recognition receptors in health and diseases[J]. Signal Transduct Target Ther, 2021, 6 (1): 291.
8
Wang PZ, Li ZD, Yu HT, et al. Elevated serum concentrations of inflammatory cytokines and chemokines in patients with haemorrhagic fever with renal syndrome[J]. J Int Med Res, 2012, 40 (2): 648-656.
9
常泽楠,温仕宏,张义楠,等.脓毒症中内皮细胞高通透性的机制研究进展[J/CD].中华危重症医学杂志(电子版)202215(4):337-342.
10
Jiang H, Du H, Wang LM, et al. Hemorrhagic fever with renal syndrome: pathogenesis and clinical picture[J]. Front Cell Infect Microbiol, 2016 (6): 1.
11
Song JW, Zullo J, Lipphardt M, et al. Endothelial glycocalyx—the battleground for complications of sepsis and kidney injury[J]. Nephrol Dial Transplant, 2018, 33 (2): 203-211.
12
Joffre J, Hellman J, Ince C, et al. Endothelial responses in sepsis[J]. Am J Respir Crit Care Med, 2020, 202 (3): 361-370.
13
Villalba N, Baby S, Yuan SY. The endothelial glycocalyx as a double-edged sword in microvascular homeostasis and pathogenesis[J]. Front Cell Dev Biol, 2021 (9): 711003.
14
彭晓欢,李莉娟,张鸿彬,等.免疫血栓形成——脓毒症中的一把"双刃剑" [J/CD].中华危重症医学杂志(电子版)202215(3):241-245.
15
Mackman N, Grover SP, Antoniak S. Tissue factor expression, extracellular vesicles, and thrombosis after infection with the respiratory viruses influenza A virus and coronavirus[J]. J Thromb Haemost, 2021, 19 (11): 2652-2658.
16
Gupta A, Madhavan MV, Sehgal K, et al. Extrapulmonary manifestations of COVID-19[J]. Nat Med, 2020, 26 (7): 1017-1032.
17
卫夏迪,刘虹,李福东,等.脓毒症T淋巴细胞的研究进展[J/CD].中华危重症医学杂志(电子版)202114(4):327-330.
18
孙剑会,刘迪,张华才,等.病毒性脓毒症的发病机制及其对严重急性呼吸综合征冠状病毒2脓毒症治疗的指导意义[J/CD].中华危重症医学杂志(电子版)202013(1):8-14.
19
Diao B, Wang C, Tan Y, et al. Reduction and functional exhaustion of T cells in patients with coronavirus disease 2019 (COVID-19)[J]. Front Immunol, 2020 (11): 827.
20
Vandewalle J, Luypaert A, De Bosscher K, et al. Therapeutic mechanisms of glucocorticoids[J]. Trends Endocrinol Metab, 2018, 29 (1): 42-54.
21
Panettieri RA, Schaafsma D, Amrani Y, et al. Non-genomic effects of glucocorticoids: an updated view[J]. Trends Pharmacol Sci, 2019, 40 (1): 38-49.
22
Chen RC, Tang XP, Tan SY, et al. Treatment of severe acute respiratory syndrome with glucosteroids: the Guangzhou experience[J]. Chest, 2006, 129 (6): 1441-1452.
23
Sayce AC, Miller JL, Zitzmann N. Glucocorticosteroids as dengue therapeutics: resolving clinical observations with a primary human macrophage model[J]. Clin Infect Dis, 2013, 56 (6): 901-903.
24
Baseler L, Chertow DS, Johnson KM, et al. The pathogenesis of ebola virus disease[J]. Annu Rev Pathol, 2017 (12): 387-418.
25
Brisse E, Wouters CH, Matthys P. Advances in the pathogenesis of primary and secondary haemophagocytic lymphohistiocytosis: differences and similarities[J]. Br J Haematol, 2016, 174 (2): 203-217.
26
国家卫生健康委员会,国家中医药管理局.儿童腺病毒肺炎诊疗规范(2019年版)[J].传染病信息201932(4):293-298.
27
张明真,何海燕,吕波,等.激素治疗腺病毒感染脓毒症的临床研究[J].中国医药指南201614(18):25,26.
28
Vandewalle J, Libert C. Glucocorticoids in sepsis: to be or not to be[J]. Front Immunol, 2020 (11): 1318.
29
Shimba A, Cui G, Tani-Ichi S, et al. Glucocorticoids drive diurnal oscillations in T cell distribution and responses by inducing interleukin-7 receptor and CXCR4[J]. Immunity, 2018, 48 (2): 286-298.e6.
30
Quatrini L, Wieduwild E, Escaliere B, et al. Endogenous glucocorticoids control host resistance to viral infection through the tissue-specific regulation of PD-1 expression on NK cells[J]. Nat Immunol, 2018, 19 (9): 954-962.
31
Heming N, Sivanandamoorthy S, Meng P, et al. Immune effects of corticosteroids in sepsis[J]. Front Immunol, 2018 (9): 1736.
32
Ehrchen JM, Roth J, Barczyk-Kahlert K. More than suppression: glucocorticoid action on monocytes and macrophages[J]. Front Immunol, 2019 (10): 2028.
33
Mathew D, Giles JR, Baxter AE, et al. Deep immune profiling of COVID-19 patients reveals distinct immunotypes with therapeutic implications[J]. Science, 2020, 369 (6508): eabc8511.
34
杨硕,苏斌涛,陈菁,等.糖皮质激素对新型冠状病毒肺炎患者T淋巴细胞亚群的影响[J].中国呼吸与危重监护杂志202120(3):159-163.
35
Wang F, Nie J, Wang H, et al. Characteristics of peripheral lymphocyte subset alteration in COVID-19 pneumonia[J]. J Infect Dis, 2020, 221 (11): 1762-1769.
36
Chappell D, Hofmann-Kiefer K, Jacob M, et al. TNF-alpha induced shedding of the endothelial glycocalyx is prevented by hydrocortisone and antithrombin[J]. Basic Res Cardiol, 2009, 104 (1): 78-89.
37
Rinaldi S, Adembri C, Grechi S, et al. Low-dose hydrocortisone during severe sepsis: effects on microalbuminuria[J]. Crit Care Med, 2006, 34 (9): 2334-2339.
38
中华预防医学会感染性疾病防控分会,中华医学会感染病学分会.肾综合征出血热防治专家共识[J].中华传染病杂志202139(5):257-265.
39
Kularatne SA. Survey on the management of dengue infection in Sri Lanka: opinions of physicians and pediatricians[J]. Southeast Asian J Trop Med Public Health, 2005, 36 (5): 1198-1200.
40
Min M, U T, Aye M, et al. Hydrocortisone in the management of dengue shock syndrome[J]. Southeast Asian J Trop Med Public Health, 1975, 6 (4): 573-579.
41
Zhang F, Kramer CV. Corticosteroids for dengue infection[J]. Cochrane Database Syst Rev, 2014 (7): CD003488.
42
Shi WL, Zhang T, Zhou JR, et al. Rapid permissive action of dexamethasone on the regulation of blood pressure in a rat model of septic shock[J]. Biomed Pharmacother, 2016 (84): 1119-1125.
43
Evans L, Rhodes A, Alhazzani W, et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021[J]. Intensive Care Med, 2021, 47 (11): 1181-1247.
44
Fougères E, Teboul JL, Richard C, et al. Hemodynamic impact of a positive end-expiratory pressure setting in acute respiratory distress syndrome: importance of the volume status[J]. Crit Care Med, 2010, 38 (3): 802-807.
45
Kan M, Himes BE. Insights into glucocorticoid responses derived from omics studies[J]. Pharmacol Ther, 2021 (218): 107674.
46
Bhoelan S, Langerak T, Noack D, et al. Hypopituitarism after orthohantavirus infection: what is currently known?[J]. Viruses, 2019, 11 (4): 340.
47
Aneja R, Carcillo JA. What is the rationale for hydrocortisone treatment in children with infection-related adrenal insufficiency and septic shock?[J]. Arch Dis Child, 2007, 92 (2): 165-169.
48
Annane D, Pastores SM, Rochwerg B, et al. Guidelines for the diagnosis and management of critical illness-related corticosteroid insufficiency (CIRCI) in critically ill patients (Part I): Society of Critical Care Medicine (SCCM) and European Society of Intensive Care Medicine (ESICM) 2017[J]. Intensive Care Med, 2017, 43 (12): 1751-1763.
49
Liang H, Song H, Zhai R, et al. Corticosteroids for treating sepsis in adult patients: a systematic review and meta-analysis[J]. Front Immunol, 2021 (12): 709155.
50
Vial PA, Valdivieso F, Ferres M, et al. High-dose intravenous methylprednisolone for hantavirus cardiopulmonary syndrome in Chile: a double-blind, randomized controlled clinical trial[J]. Clin Infect Dis, 2013, 57 (7): 943-951.
51
郭琴琴,曹大伟,张喆,等.糖皮质激素在病毒性肺炎中的应用[J].国际呼吸杂志202141(11):825-830.
52
Li H, Yang SG, Gu L, et al. Effect of low-to-moderate-dose corticosteroids on mortality of hospitalized adolescents and adults with influenza A (H1N1)pdm09 viral pneumonia[J]. Influenza Other Respir Viruses, 2017, 11 (4): 345-354.
53
RECOVERY Collaborative Group. Dexamethasone in hospitalized patients with Covid-19[J]. N Engl J Med, 2021, 384 (8): 693-704.
54
WHO Rapid Evidence Appraisal for COVID-19 Therapies (REACT) Working Group. Association between administration of systemic corticosteroids and mortality among critically ill patients with COVID-19: a meta-analysis[J]. JAMA, 2020, 324 (13): 1330-1341.
55
Sweeney TE, Azad TD, Donato M, et al. Unsupervised analysis of transcriptomics in bacterial sepsis across multiple datasets reveals three robust clusters[J]. Crit Care Med, 2018, 46 (6): 915-925.
56
Antcliffe DB, Burnham KL, Al-Beidh F, et al. Transcriptomic signatures in sepsis and a differential response to steroids. from the VANISH randomized trial[J]. Am J Respir Crit Care Med, 2019, 199 (8): 980-986.
No related articles found!
阅读次数
全文


摘要