脓毒症免疫麻痹与细胞免疫调理治疗研究进展

Advances in cellular immunomodulatory therapy in patients with sepsis and immune compromized

脓毒症是目前引起ICU患者死亡的主要原因之一，其高病死率的原因可能与具体病理生理机制的认识不清楚相关，作为一种复杂的多系统、多机制疾病，免疫炎症系统反应紊乱可能是其主要机制之一，脓毒症免疫紊乱主要表现为炎症因子风暴和免疫麻痹，免疫麻痹的机制可能包括：免疫细胞凋亡、免疫细胞抑制和免疫细胞耗竭。本文就脓毒症免疫麻痹发生病理生理机制、免疫监测、细胞免疫调理治疗作一综述，以其提高脓毒症免疫抑制认识。

Sepsis is one of the most common causes of mortality in the intensive care units （ICUs） with high mortality rates which may be related to the lack of thoroughly understanding of the specific pathophysiological mechanisms. Improved treatment protocols have resuhed in most patients got out of the initial hyperinflammatory phase and entered into a protracted immune suppressed phase. Deaths in this immunosuppressive phase are typically due to failure to control the primary infection or the secondary nosocomial infections often with opportunistic pathogens. As the complexity in multiple systems and varied mechanisms involved in the development of disease, the disorder of immune system and inflammation reaction may be one of the main mechanisms, which were mainly characterized by inflammation cytokines storm and immune dysfunction. The mechanism in the later course of disease may include apoptosis and depletion of immune cells, increased suppression of T regulatory cell and increased myeloid-derivedsuppressor cell, and cellular exhaustion. In this review we focus on the pathophysiologic mechanism of sepsis with immune compromized, monitoring the immune response, the cellular immunoadjuvant therapy, and improving the recognition of sepsis immunosuppression.