切换至 "中华医学电子期刊资源库"

第五届中国出版政府奖音像电子网络出版物奖提名奖

中国科技核心期刊

中国科学引文数据库(CSCD)来源期刊

中华重症医学电子杂志 ›› 2025, Vol. 11 ›› Issue (02) : 152 -156. doi: 10.3877/cma.j.issn.2096-1537.2025.02.010

专家论坛

脓毒症肺损伤治疗:突破与创新的必要性
徐优1, 郭强1,()   
  1. 1. 215100 苏州,苏州大学附属第四医院 苏州市独墅湖医院
  • 收稿日期:2025-01-29 出版日期:2025-05-28
  • 通信作者: 郭强

Treatment of sepsis-induced lung injury:the necessity of breakthroughs and innovations

You Xu1, Qiang Guo1,()   

  1. 1. The Fourth Affiliated Hospital of Soochow University,Suzhou Dushu Lake Hospital,Suzhou 215000,China
  • Received:2025-01-29 Published:2025-05-28
  • Corresponding author: Qiang Guo
引用本文:

徐优, 郭强. 脓毒症肺损伤治疗:突破与创新的必要性[J/OL]. 中华重症医学电子杂志, 2025, 11(02): 152-156.

You Xu, Qiang Guo. Treatment of sepsis-induced lung injury:the necessity of breakthroughs and innovations[J/OL]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2025, 11(02): 152-156.

脓毒症易涉及肺,常合并脓毒症肺损伤,其发生率及病死率均较高,但现有治疗方案无法有效降低患者病死率,因此需寻找更有效的治疗措施。本文就近年来关于脓毒症肺损伤的机制与治疗的发展进行分析,并提出可能的创新性治疗方向。

Sepsis frequently involve the lungs and is often complicated with sepsis-induced lung injury,which has a high incidence and mortality rate.However,current treatment strategies have not effectively reduce the mortality.Necessitating the exploration of more effective therapeutic measures.This article analyzes the recent development of the mechanisms and treatments of sepsis-induced lung injury and proposes possible innovative therapeutic directions.

图1 脓毒症肺损伤相关机制 注:IL-6 为白介素6;TNF 为肿瘤坏死因子;NETs为中性粒细胞胞外诱捕网;ROS 为活性氧;MMPs 为基质金属蛋白酶
图2 脓毒症肺损伤治疗方法
1
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.
2
Sadowitz B,Roy S,Gatto LA,et al.Lung injury induced by sepsis:lessons learned from large animal models and future directions for treatment [J].Expert Rev Anti Infect Ther,2011,9(12):1169-1178.
3
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.
4
Kumar V.Pulmonary innate immune response determines the outcome of inflammation during pneumonia and sepsis-associated acute lung injury [J].Front Immunol,2020,11:1722.
5
Wang Z,Wang Z.The role of macrophages polarization in sepsisinduced acute lung injury [J].Front Immunol,2023,14:1209438.
6
Zou S,Jie H,Han X,et al.The role of neutrophil extracellular traps in sepsis and sepsis-related acute lung injury [J].Int Immunopharmacol,2023,124(Pt A):110436.
7
Gong H,Chen Y,Chen M,et al.Advanced development and mechanism of sepsis-related acute respiratory distress syndrome [J].Front Med (Lausanne),2022,9:1043859.
8
Sun B,Lei M,Zhang J,et al.Acute lung injury caused by sepsis:how does it happen? [J].Front Med (Lausanne),2023,10:1289194.
9
Bastani MN,Jalilian S.Unraveling the enigma:the emerging significance of pulmonary surfactant proteins in predicting,diagnosing,and managing COVID-19 [J].Immun Inflamm Dis,2024,12(6):e1302.
10
Wang W,Xu R,Zhao H,et al.CircEXOC5 promotes ferroptosis by enhancing ACSL4 mRNA stability via binding to PTBP1 in sepsisinduced acute lung injury [J].Immunobiology,2022,227(4):152219.
11
Li Y,Cao Y,Xiao J,et al.Inhibitor of apoptosis-stimulating protein of p53 inhibits ferroptosis and alleviates intestinal ischemia/reperfusioninduced acute lung injury [J].Cell Death Differ,2020,27(9):2635-2650.
12
Zhou X,Liao Y.Gut-lung crosstalk in sepsis-induced acute lung injury[J].Front Microbiol,2021,12:779620.
13
Jiang L,Feng H,Chen X,et al.Low tidal volume reduces lung inflammation induced by liquid ventilation in piglets with severe lung injury [J].Artif Organs,2017,41(5):440-445.
14
Fernandes M,Rocha NN,Felix NS,et al.A more gradual positive end-expiratory pressure increase reduces lung damage and improves cardiac function in experimental acute respiratory distress syndrome[J].J Appl Physiol (1985),2022,132(2):375-387.
15
Guerin C,Reignier J,Richard JC,et al.Prone positioning in severe acute respiratory distress syndrome [J].N Engl J Med,2013,368(23):2159-2168.
16
Sun Q,Qiu H,Huang M,et al.Lower mortality of COVID-19 by early recognition and intervention:experience from Jiangsu Province [J].Ann Intensive Care,2020,10(1):33.
17
Schmidt M,Hajage D,Lebreton G,et al.Prone positioning during extracorporeal membrane oxygenation in patients with severe ARDS:the PRONECMO randomized clinical trial [J].JAMA,2023,330(24):2343-2353.
18
Du Q,Dickinson A,Nakuleswaran P,et al.Targeting macrophage polarization for reinstating homeostasis following tissue damage [J].Int J Mol Sci,2024,25(13).
19
Horby P,Lim WS,Emberson JR,et al.Dexamethasone in hospitalized patients with COVID-19 [J].N Engl J Med,2021,384(8):693-704.
20
Dequin PF,Meziani F,Quenot JP,et al.Hydrocortisone in severe community-acquired pneumonia [J].N Engl J Med,2023,388(21):1931-1941.
21
杨铃清,马辰东,王雷,等.光甘草定调控NETs 抑制细胞焦亡缓解脓毒症肺损伤机制 [J].中华急诊医学杂志,2024,33(2):179-185.
22
Li J,Xuan R,Wu W,et al.CTRP6 suppresses neutrophil extracellular traps formation to ameliorate sepsis-induced lung injury through inactivation of ERK pathway [J].Allergol Immunopathol (Madr),2022,50(6):53-59.
23
Liang P,Wang L,Yang S,et al.5-Methoxyflavone alleviates LPSmediated lung injury by promoting Nrf2-mediated the suppression of NOX4/TLR4 axis in bronchial epithelial cells and M1 polarization in macrophages [J].J Inflamm (Lond),2022,19(1):24.
24
Shutong L,Yu J,Jia W,et al.HO-1/autophagic flux axis alleviated sepsis-induced acute lung injury via inhibiting NLRP3 inflammasome[J].Cell Signal,2022,100:110473.
25
Sun Y,Liu G,Zhang K,et al.Mesenchymal stem cells-derived exosomes for drug delivery [J].Stem Cell Res Ther,2021,12(1):561.
26
Bai X,Li J,Li L,et al.Extracellular vesicles from adipose tissuederived stem cells affect Notch-miR148a-3p axis to regulate polarization of macrophages and alleviate sepsis in mice [J].Front Immunol,2020,11:1391.
27
蔡维霞,沈括,曹涛,等.人脂肪间充质干细胞来源外泌体对脓毒症小鼠肺血管内皮细胞损伤的影响及其机制 [J].中华烧伤与创面修复杂志,2022,38(3):266-275.
28
胡婉,姚明丽,唐可京,等.免疫调理联合骨髓间充质干细胞改善大鼠脓毒症所致肺损伤 [J].中华实验外科杂志,2019,36(4):674-678.
29
Yang R,Zhang X.A potential new pathway for heparin treatment of sepsis-induced lung injury:inhibition of pulmonary endothelial cell pyroptosis by blocking hMGB1-LPS-induced caspase-11 activation[J].Front Cell Infect Microbiol,2022,12:984835.
30
Liu B,Wang Z,He R,et al.Buformin alleviates sepsis-induced acute lung injury via inhibiting NLRP3-mediated pyroptosis through an AMPK-dependent pathway [J].Clin Sci (Lond),2022,136(4):273-289.
31
He R,Liu B,Xiong R,et al.Itaconate inhibits ferroptosis of macrophage via Nrf2 pathways against sepsis-induced acute lung injury [J].Cell Death Discov,2022,8(1):43.
32
Tang Y,Wang X,Li Z,et al.Heparin prevents caspase-11-dependent septic lethality independent of anticoagulant properties [J].Immunity,2021,54(3):454-467.
33
Ooijevaar RE,Terveer EM,Verspaget HW,et al.Clinical application and potential of fecal microbiota transplantation [J].Annu Rev Med,2019,70:335-351.
34
Li W,Li D,Chen Y,et al.Classic signaling pathways in alveolar injury and repair involved in sepsis-induced ALI/ARDS:new research progress and prospect [J].Dis Markers,2022,2022:6362344.
35
Li N,Liu B,Xiong R,et al.HDAC3 deficiency protects against acute lung injury by maintaining epithelial barrier integrity through preserving mitochondrial quality control [J].Redox Biol,2023,63:102746.
36
You T,Zhang B.CircWDR33 alleviates human pulmonary microvascular endothelial cell injury in sepsis-associated acute lung injury by targeting miR-217-5p/SERP1 axis [J].Int Immunopharmacol,2022,113(Pt B):109440.
37
陆莎莎,王璐瑶,张新宇,等.血必净注射液抑制肺泡巨噬细胞焦亡改善脓毒症诱导的小鼠急性肺损伤 [J].中国中西医结合急救杂志,2023,30(4):418-423.
38
李珊,王艳玲,黄冬林,等.血必净通过调控自噬减轻脓毒症炎症反应和肺损伤的实验研究 [J].中国中西医结合急救杂志,2022,29(4):412-416.
39
Bhowmick NA,Oft J,Dorff T,et al.COVID-19 and androgen-targeted therapy for prostate cancer patients [J].Endocr Relat Cancer,2020,27(9):R281-R292.
40
Ning L,Rong J,Zhang Z,et al.Therapeutic approaches targeting renin-angiotensin system in sepsis and its complications [J].Pharmacol Res,2021,167:105409.
[1] 王梦洁, 张董晓. 囊性中性粒细胞性肉芽肿性乳腺炎发病机制及诊疗进展[J/OL]. 中华乳腺病杂志(电子版), 2025, 19(01): 39-44.
[2] 韩丽飞, 张亚男, 胡浩霖, 吕建鑫, 曹欣华. 三阴性乳腺癌发生机制的信号传导通路[J/OL]. 中华乳腺病杂志(电子版), 2019, 13(02): 115-117.
[3] 中国性病艾滋病防治协会学术委员会外科学组, 中华医学会热带病与寄生虫学分会外科学组, 国家传染病医学中心(北京). 中国人类免疫缺陷病毒感染者围手术期抗病毒治疗专家共识(第二版)[J/OL]. 中华实验和临床感染病杂志(电子版), 2021, 15(05): 289-294.
[4] 马睿, 张强. 获得性免疫缺陷综合征患者脊柱亚临床骨折研究进展[J/OL]. 中华实验和临床感染病杂志(电子版), 2019, 13(03): 181-184.
[5] 丛赟, 李国煜, 王丹妮, 邵英梅, 吐尔干艾力·阿吉. 肝细胞癌行根治性肝切除术后复发治疗新进展[J/OL]. 中华普通外科学文献(电子版), 2024, 18(02): 137-141.
[6] 赵淼, 蔡兵, 顾澄宇. 进展期肝门部胆管癌治疗策略选择与预后的关系[J/OL]. 中华普外科手术学杂志(电子版), 2018, 12(05): 388-391.
[7] 郝昭昭, 李多, 南岩东. 以肺磨玻璃结节为表现的肺腺癌发生机制研究进展[J/OL]. 中华肺部疾病杂志(电子版), 2023, 16(03): 435-437.
[8] 雷丽均, 赵才林, 徐静. 急性肺栓塞的研究进展[J/OL]. 中华肺部疾病杂志(电子版), 2022, 15(01): 127-128.
[9] 国超凡, 彭琪博, 郑章强, 于向阳. 低位前切除综合征风险预测及治疗的研究进展[J/OL]. 中华结直肠疾病电子杂志, 2024, 13(04): 335-340.
[10] 阳莹, 崔亚梅, 邵强, 赵宁, 陶文强, 陈家泉, 徐泽尧, 钱克俭, 刘芬. 线粒体自噬对肺泡巨噬细胞焦亡的调控作用及其机制[J/OL]. 中华重症医学电子杂志, 2023, 09(01): 69-77.
[11] 李田, 徐洪, 刘和亮. 尘肺病的相关研究进展[J/OL]. 中华临床医师杂志(电子版), 2023, 17(08): 900-905.
[12] 王磊, 咸玉涛, 杨正强, 施海彬. 不同治疗方案对晚期肝细胞性肝癌预后的影响及因素分析[J/OL]. 中华介入放射学电子杂志, 2018, 06(02): 104-108.
[13] 张恒达, 刘超, 孙雪峰. 内环境对肾脏衰老的影响[J/OL]. 中华老年病研究电子杂志, 2019, 06(02): 35-39.
[14] 苏建龙, 甄文剑, 孙宇婷, 郝进敏. CT 脑灌注在大面积脑梗死患者病情评估及手术方案设计中的应用[J/OL]. 中华脑血管病杂志(电子版), 2025, 19(02): 133-140.
[15] 洪靖舒, 韩登阳, 郭向阳. 神经血管单元在脑小血管病中的研究进展[J/OL]. 中华脑血管病杂志(电子版), 2022, 16(01): 48-52.
阅读次数
全文


摘要


AI


AI小编
你好!我是《中华医学电子期刊资源库》AI小编,有什么可以帮您的吗?