脓毒症免疫联合治疗研究进展

Advances in combined immunotherapy for sepsis

脓毒症是一种严重危及生命的多器官功能障碍性疾病,具有较高的发病率和病死率,如何攻克脓毒症仍是一个世界性难题。2016年的《脓毒症与脓毒症休克国际共识》表明脓毒症的发生与宿主的免疫反应有关,合理精准地运用免疫调理方案来综合治疗脓毒症成为目前的研究热点。脓毒症的发病过程可分为系统性炎症反应期和代偿性抗炎反应期,相应的免疫调理措施分别是抗感染治疗和免疫激活治疗。尽管免疫治疗可在一定程度上降低患者的病死率,但是如何最大限度地提高脓毒症患者的生存率仍然是研究的难点。当前,免疫联合治疗在癌症领域广泛开展且疗效显著,而在脓毒症领域的研究开展得还较少。该文对近10年来脓毒症的免疫联合治疗研究进行总结,包括糖皮质激素间的联合,白介素与免疫检查点抑制剂的联合,中药血必净注射液、胸腺肽α1与其他药物的联合,等等。免疫联合治疗在脓毒症领域已初见成效,并且展现出巨大的潜力和发展空间,有望在将来成为新的治疗策略,为脓毒症的治疗带来突破。

Sepsis is a serious life-threatening multiple organ dysfunction disease with high morbidity and mortality, how to conquer sepsis is a worldwide problem. According to the latest international consensus, the occurrence of sepsis is associated with the host’s immune response, so reasonable and accurate use of immune regulating scheme for comprehensive treatment of sepsis will be the research hot spot. The pathogenesis of sepsis can be simply divided into the stage of systemic inflammatory response and stage of compensatory anti-inflammatory response, corresponding immune regulating measures are anti-inflammatory therapy and immunostimulation therapy respectively. Although immunotherapy has reduced the mortality of patients to some extent, how to maximize the survival rate of sepsis patients is still a difficulty. Currently, immune combined therapy is carried out widely in the field of cancer treatment, and the therapeutic effect is significant, but in the field of sepsis, immune combined therapy research is less.This article summarizes the recent 10 years’ advances in immune combined therapy for sepsis, including the combination between glucocorticoid, that between interleukin and immune checkpoint inhibitor, and that between both Chinese medicine Xuebijing injection and thymosin alpha 1 and other drugs, etc. Immune combined therapy has achieved initial success in the field of sepsis,and shows a great potential and development space. It is believed that in the near future, immune combined therapy is expected to become a new therapeutic strategy and bring breakthrough for the treatment of sepsis.