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中华重症医学电子杂志 ›› 2025, Vol. 11 ›› Issue (02) : 105 -111. doi: 10.3877/cma.j.issn.2096-1537.2025.02.001

年度进展

脓毒症凝血功能障碍:2024 年度进展与展望
张丽娜1, 谌楚宇1, 杨新宇2, 邱海波3,(), 吕奔4,5,()   
  1. 1. 410008 长沙,中南大学湘雅医院重症医学科
    2. 410008 长沙,中南大学湘雅医院血液科
    3. 210009 南京,东南大学附属中大医院重症医学科
    4. 410011 长沙,中南大学湘雅二医院
    5. 410013 长沙,中南大学湘雅三医院
  • 收稿日期:2025-01-31 出版日期:2025-05-28
  • 通信作者: 邱海波, 吕奔
  • 基金资助:
    国家杰出青年科学基金项目(82025021)四大慢病重大专项(2023ZD0506500)湖南创新型省份建设专项重点研发计划项目(2023SK2020)

Sepsis-induced coagulopathy:progress and prospects in 2024

Lina Zhang1, Chuyu Shen1, Xinyu Yang2, Haibo Qiu3,(), Ben Lyu4,5,()   

  1. 1. Department of Critical Care Mediciney,Xiangya Hospital,Central South University,Changsha 410008,China
    2. Department of Hematology,Xiangya Hospital,Central South University,Changsha 410008,China
    3. Department of Critical Care Medicine,Zhongda Hospital,School of Medicine,Southeast University,Nanjing 210009,China
    4. The Second Xiangya Hospital,Central South University,Changsha 410011,China
    5. The Third Xiangya Hospital,Central South University,Changsha 410013,China
  • Received:2025-01-31 Published:2025-05-28
  • Corresponding author: Haibo Qiu, Ben Lyu
引用本文:

张丽娜, 谌楚宇, 杨新宇, 邱海波, 吕奔. 脓毒症凝血功能障碍:2024 年度进展与展望[J/OL]. 中华重症医学电子杂志, 2025, 11(02): 105-111.

Lina Zhang, Chuyu Shen, Xinyu Yang, Haibo Qiu, Ben Lyu. Sepsis-induced coagulopathy:progress and prospects in 2024[J/OL]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2025, 11(02): 105-111.

脓毒症常伴随复杂的凝血功能障碍,尤其是弥散性血管内凝血(DIC),可显著加重患者病情并增加死亡风险。尽管近年来治疗手段有所进展,脓毒症凝血功能障碍(SIC)仍是临床上的重要挑战。最新研究揭示了SIC 的相关机制,并发现了潜在的治疗靶点,为临床干预提供了新策略。本文综述2024 年以来在SIC 领域的研究进展,分析当前治疗趋势,并展望未来的研究方向。

Sepsis is often accompanied by complex coagulation dysfunction,particularly disseminated intravascular coagulation (DIC),which significantly exacerbates disease severity and increases mortality.Despite advances in therapeutic approaches in recent years,sepsis-induced coagulopathy (SIC) remains a significant clinical challenge.Recent studies have elucidated the underlying mechanisms of SIC and identified novel therapeutic targets,providing potential treatment strategies for clinical practice.We summarize the latest research progress in SIC dysfunction,analyze current treatment trends,and explore future research directions.

1
Xie J,Wang H,Kang Y,et al.The epidemiology of sepsis in Chinese ICUs:a national cross-sectional survey [J].Crit Care Med,2020,48(3):e209-e218.
2
Schmoch T,Mohnle P,Weigand MA,et al.The prevalence of sepsisinduced coagulopathy in patients with sepsis - a secondary analysis of two German multicenter randomized controlled trials [J].Ann Intensive Care,2023,13(1):3.
3
Tanaka C,Tagami T,Kudo S,et al.Validation of sepsis-induced coagulopathy score in critically ill patients with septic shock:post hoc analysis of a nationwide multicenter observational study in Japan [J].Int J Hematol,2021,114(2):164-171.
4
Levi M,Van Der Poll T.Coagulation and sepsis [J].Thromb Res,2017,149:38-44.
5
Cecconi M,Evans L,Levy M,et al.Sepsis and septic shock [J].Lancet,2018,392(10141):75-87.
6
Williams B,Zou L,Pittet JF,et al.Sepsis-induced coagulopathy:a comprehensive narrative review of pathophysiology,clinical presentation,diagnosis,and management strategies [J].Anesth Analg,2024,138(4):696-711.
7
Iba T,Helms J,Levy JH.Sepsis-induced coagulopathy (SIC) in the management of sepsis [J].Ann Intensive Care,2024,14(1):148.
8
Maneta E,Aivalioti E,Tual-Chalot S,et al.Endothelial dysfunction and immunothrombosis in sepsis [J].Front Immunol,2023,14:1144229.
9
Navarrete S,Solar C,Tapia R,et al.Pathophysiology of deep vein thrombosis [J].Clin Exp Med,2023,23(3):645-654.
10
Portier I,Campbell RA.Role of platelets in detection and regulation of infection [J].Arterioscler Thromb Vasc Biol,2021,41(1):70-78.
11
Guo L,Shen S,Rowley JW,et al.Platelet MHC class Ⅰ mediates CD8+T-cell suppression during sepsis [J].Blood,2021,138(5):401-416.
12
Leung G,Middleton EA.The role of platelets and megakaryocytes in sepsis and ARDS [J].J Physiol,2024,602(22):6047-6063.
13
Rondina MT,Carlisle M,Fraughton T,et al.Platelet-monocyte aggregate formation and mortality risk in older patients with severe sepsis and septic shock [J].J Gerontol A Biol Sci Med Sci,2015,70(2):225-231.
14
Su M,Chen C,Li S,et al.Gasdermin D-dependent platelet pyroptosis exacerbates NET formation and inflammation in severe sepsis [J].Nat Cardiovasc Res,2022,1(8):732-747.
15
Herre M,Cedervall J,Mackman N,et al.Neutrophil extracellular traps in the pathology of cancer and other inflammatory diseases [J].Physiol Rev,2023,103(1):277-312.
16
宋景春,丁仁彧,吕奔,等.脓毒症性凝血病诊疗中国专家共识(2024 版) [J].解放军医学杂志,2024,49(11):1221-1236.
17
Deng M,Tang Y,Li W,et al.The endotoxin delivery protein HMGB1 mediates caspase-11-dependent lethality in sepsis [J].Immunity,2018,49(4):740-753 e7.
18
Vanaja SK,Russo AJ,Behl B,et al.Bacterial outer membrane vesicles mediate cytosolic localization of LPS and Caspase-11 activation [J].Cell,2016,165(5):1106-1119.
19
Yang X,Cheng X,Tang Y,et al.Bacterial endotoxin activates the coagulation cascade through Gasdermin D-dependent phosphatidylserine exposure [J].Immunity,2019,51(6):983-996.e6.
20
Wu C,Lu W,Zhang Y,et al.Inflammasome activation triggers blood clotting and host death through pyroptosis [J].Immunity,2019,50(6):1401-1411.e4.
21
Zhang H,Zeng L,Xie M,et al.TMEM173 drives lethal coagulation in sepsis [J].Cell Host Microbe,2020,27(4):556-570.e6.
22
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.
23
Wang H,Ding H,Wang ZY,et al.Research progress on microcirculatory disorders in septic shock:a narrative review [J].Medicine (Baltimore),2024,103(8):e37273.
24
Tobiasch AK,Lehner GF,Feistritzer C,et al.Extracellular vesicle tissue factor and tissue factor pathway inhibitor are independent discriminators of sepsis-induced coagulopathy [J].Res Pract Thromb Haemost,2024,8(7):102596.
25
Ninan KF,Iyadurai R,Varghese JK,et al.Thromboelastograph:a prognostic marker in sepsis with organ dysfunction without overt bleeding [J].J Crit Care,2021,65:177-183.
26
Damiani E,Carsetti A,Casarotta E,et al.Microcirculation-guided resuscitation in sepsis:the next frontier? [J].Front Med (Lausanne),2023,10:1212321.
27
Zhang J,Xue M,Chen Y,et al.Identification of soluble thrombomodulin and tissue plasminogen activator-inhibitor complex as biomarkers for prognosis and early evaluation of septic shock and sepsis-induced disseminated intravascular coagulation [J].Ann Palliat Med,2021,10(10):10170-10184.
28
Li J,Zhou J,Ren H,et al.Clinical efficacy of soluble thrombomodulin,tissue plasminogen activator inhibitor complex,thrombin-antithrombin complex,alpha2-plasmininhibitor-plasmin complex in pediatric sepsis[J].Clin Appl Thromb Hemost,2022,28:10760296221102929.
29
Delabranche X,Boisrame-Helms J,Asfar P,et al.Microparticles are new biomarkers of septic shock-induced disseminated intravascular coagulopathy [J].Intensive Care Med,2013,39(10):1695-1703.
30
Stiel L,Delabranche X,Galoisy AC,et al.Neutrophil fluorescence:a new indicator of cell activation during septic shock-induced disseminated intravascular coagulation [J].Crit Care Med,2016,44(11):e1132-e1136.
31
Shimizu M,Konishi A,Nomura S.Examination of biomarker expressions in sepsis-related DIC patients [J].Int J Gen Med,2018,11:353-361.
32
Stiel L,Mayeur-Rousse C,Helms J,et al.First visualization of circulating neutrophil extracellular traps using cell fluorescence during human septic shock-induced disseminated intravascular coagulation [J].Thromb Res,2019,183:153-158.
33
Galliera E,Tacchini L,Corsi Romanelli MM.Matrix metalloproteinases as biomarkers of disease:updates and new insights[J].Clin Chem Lab Med,2015,53(3):349-355.
34
Lorente L,Martin MM,Sole-Violan J,et al.Association of sepsisrelated mortality with early increase of TIMP-1/MMP-9 ratio [J].PLoS One,2014,9(4):e94318.
35
Sivula M,Hastbacka J,Kuitunen A,et al.Systemic matrix metalloproteinase-8 and tissue inhibitor of metalloproteinases-1 levels in severe sepsis-associated coagulopathy [J].Acta Anaesthesiol Scand,2015,59(2):176-184.
36
Zhang Y,Wang L,Kuang X,et al.Diagnostic and prognostic value of C1q in sepsis-induced coagulopathy [J].Clin Appl Thromb Hemost,2024,30:10760296241257517.
37
Sun Y,Sun H,Feng J,et al.Immunosuppression correlates with the deterioration of sepsis-induced disseminated intravascular coagulation[J].Shock,2024,61(5):666-674.
38
Han Y,Duan J,Chen M,et al.Relationship between serum sodium level and sepsis-induced coagulopathy [J].Front Med (Lausanne),2023,10:1324369.
39
Kiya GT,Abebe G,Mekonnen Z,et al.A comparison of disseminated intravascular coagulation scoring systems and their performance to predict mortality in sepsis patients:a systematic review and metaanalysis [J].PLoS One,2025,20(1):e0315797.
40
Zhao H,Dong Y,Wang S,et al.Comparison between sepsis-induced coagulopathy and sepsis-associated coagulopathy criteria in identifying sepsis-associated disseminated intravascular coagulation [J].World J Emerg Med,2024,15(3):190-196.
41
Zhou S,Lu Z,Liu Y,et al.Interpretable machine learning model for early prediction of 28-day mortality in ICU patients with sepsisinduced coagulopathy:development and validation [J].Eur J Med Res,2024,29(1):14.
42
Rhodes A,Evans LE,Alhazzani W,et al.Surviving sepsis campaign:international guidelines for management of sepsis and septic shock:2016 [J].Crit Care Med,2017,45(3):486-552.
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
Egi M,Ogura H,Yatabe T,et al.The Japanese clinical practice guidelines for management of sepsis and septic shock 2020 (J-SSCG 2020) [J].Acute Med Surg,2021,8(1):e659.
45
Umemura Y,Yamakawa K,Ogura H,et al.Efficacy and safety of anticoagulant therapy in three specific populations with sepsis:a metaanalysis of randomized controlled trials [J].J Thromb Haemost,2016,14(3):518-530.
46
Ushio N,Yamakawa K,Mochizuki K,et al.Efficacy of unfractionated heparin in patients with moderate sepsis-induced coagulopathy:an observational study [J].Thromb Res,2024,241:109095.
47
Wang R,Liu R,Xu Z.Association between plasma transfusion and in-hospital mortality in critically ill patients with sepsis-induced coagulopathy [J].Shock,2023,60(4):545-552.
48
Ishikura H,Nakamura Y,Kawano Y,et al.Intravenous immunoglobulin improves sepsis-induced coagulopathy:a retrospective,single-center observational study [J].J Crit Care,2015,30(3):579-583.
49
Wand S,Klages M,Kirbach C,et al.IgM-enriched immunoglobulin attenuates systemic endotoxin activity in early severe sepsis:a beforeafter cohort study [J].PLoS One,2016,11(8):e0160907.
50
Zou F,Tang X,Lei X,et al.Treatment efficacy of continuous renal replacement on symptoms,inflammatory mediators,and coagulation function in patients with sepsis-associated acute kidney injury [J].Arch Esp Urol,2022,75(9):746-752.
51
Wu S,Xu T,Wu C,et al.Continuous renal replacement therapy in sepsis-associated acute kidney injury:effects on inflammatory mediators and coagulation function [J].Asian J Surg,2021,44(10):1254-1259.
52
Osawa I,Goto T,Kudo D,et al.Targeted therapy using polymyxin B hemadsorption in patients with sepsis:a post-hoc analysis of the JSEPTIC-DIC study and the EUPHRATES trial [J].Crit Care,2023,27(1):245.
53
Aydin K,Korkmaz S,Erkurt MA,et al.Apheresis in patients with sepsis:a multicenter retrospective study [J].Transfus Apher Sci,2021,60(5):103239.
54
Zhang J,Zhu X,Li Y,et al.Parthenolide improves sepsis-induced coagulopathy by inhibiting mitochondrial-mediated apoptosis in vascular endothelial cells through BRD4/BCL-xL pathway [J].J Transl Med,2025,23(1):80.
55
Guo NK,She H,Tan L,et al.Nano Parthenolide improves intestinal barrier function of sepsis by inhibiting apoptosis and ROS via 5-HTR2A [J].Int J Nanomedicine,2023,18:693-709.
56
Zhou X,Xin G,Wan C,et al.Myricetin reduces platelet PANoptosis in sepsis to delay disseminated intravascular coagulation [J].Biochem Biophys Res Commun,2024,724:150140.
57
Zhang W,Bhandari S,Ding Y,et al.Polyunsaturated fatty acid-derived lipid mediator resolvin D1 alleviates sepsis-induced disseminated intravascular coagulation via Caspase-1/Gasdermin D pyroptotic pathway [J].Clin Nutr,2024,43(6):1372-1383.
58
Liu Z,Li X,Chen M,et al.Heparin-binding protein and sepsisinduced coagulopathy:modulation of coagulation and fibrinolysis via the TGF-beta signalling pathway [J].Thromb Res,2024,244:109176.
59
Zhong T,Zhang J,Chen S,et al.Magnesium sulfate ameliorates histone-induced coagulation dysfunction and lung damage in mice [J].Shock,2024,61(1):132-141.
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