关注神经内分泌紊乱与脓毒症的关系及其防治策略

Neuroendocrine dysfunction in sepsis and its therapeutic strategy

脓毒症时以下丘脑-垂体-肾上腺轴（hypothalamus-pituitary-adrenal axis,HPA）为代表的神经内分泌系统及自主神经系统被激活,参与机体的应激反应.近年来,脓毒症中神经内分泌的改变越来越受到重视,弄清其调节过程将有助于澄清脓毒症的病理生理机制,为探讨激素治疗的可能性开辟新途径.

Severe sepsis provokes significant abnormalities in host neuroendocrine system, and they are hallmarked by the glucocorticoid and growth hormone resistance, vasopressin deficiency, and compromised vagal activity. As a consequence, the increased stress hormones result in a hyperdynamic circulation, hypermetabolic state, and the hyperglycemia/insulin resistance in sepsis. The cardiac autonomic dysfunction also occurs as a consequence of depressed vagal activity. Current therapeutic strategies include insulin therapy to control hyperglycemi-a, physiologic doses of corticosteroids to improve immunity, growth hormone to reverse negative nitrogen balance, and vasopressin to raise blood pressure. Non-specific β-adrenergic blockade has also been attempted to either attenuate the hyperme-tabolism or to reduce the inflammatory response. Future therapy may be directed at both central and peripheral immune system so as to alleviate the hyperdynamic inflammatory state and possibly encephalopathy in severe sepsis.