严重创伤后免疫炎症反应机制及相关临床干预研究进展

Mechanism of immune inflammation after severe trauma and progress in clinical intervention

严重创伤后免疫炎症反应的病理生理过程极为复杂,尤其体现在免疫炎症反应的动态变化方面。在生理反应状态下,促炎与抗炎处于动态平衡,免疫炎症反应相对稳定,避免过度炎症反应或免疫抑制,减轻创伤对机体的进一步打击;在病理反应状态下,促炎与抗炎间的动态平衡被打破,同时还可导致持续性炎症-免疫抑制-分解代谢综合征(PICS)。从而增加失控的炎症反应、脓毒症、多器官功能障碍综合征(MODS)、多器官功能衰竭(MOF)等严重并发症。当前对创伤后免疫炎症反应的研究工作也已扩展到基因层面,基因的过度表达和免疫应答介质的产生及增加很可能是导致免疫炎症反应紊乱的关键原因。笔者就严重创伤后的免疫炎症反应机制及相关的临床干预研究进展进行综述,旨在总结前人的相关研究成果,探讨下一步的研究方向。

The pathophysiological process of immune inflammatory response after severe trauma is extremely complex, especially manifested in the dynamic changes. In the physiological response state, the inflammatory and anti-inflammatory conditions are in a dynamic balance. The immune inflammatory response is relatively stable, avoiding excessive inflammatory reactions or immunosuppression and reducing further damage to the body. In the pathological response state, the dynamic balance between inflammatory and anti-inflammatory is broken, and it can also lead to persistent inflammatory-immunosuppression-catabolism syndrome (PICS). As a result, it increases serious complications such as uncontrolled inflammatory reactions, sepsis, multiple organ dysfunction syndrome (MODS), and multiple organ failure (MOF). Current researches on post-traumatic immune inflammatory response have also expanded to the genetic level, indicating that the over-expression of genes and the generation and increase of immune response media are likely to be the key reasons for the disorder of immune inflammatory response. The author reviews the research progress of immune inflammatory response mechanism and related clinical intervention after severe trauma, in order to summarize the previous research results and explore the future research direction.