脓毒症治疗的新靶点——肠促胰素

Incretin-the new therapeutic target of sepsis

2019年11月,JCEM发表了1篇题为Therapeutic Effects of Endogenous Incretin Hormones and Exogenous Incretin-Based Medications in Sepsis[Faraaz AS,Hussain M,Teresa GM,et al.J Clin Endocrinol Metab,2019,104(11):5274-5284]的文章,在获得该刊授权后,我们对该文做中文编译。目前脓毒症的准确定义为由宿主对感染的反应失调引起的危及生命的器官功能障碍,若合并血糖异常,会增加器官功能障碍和死亡的风险,作者认为需要寻找治疗脓毒症并维持血糖稳态的新靶点。肠促胰素可以调节各种功能,包括胰岛的激素分泌、血糖水平、脂质代谢、肠道运动、食欲、体重和免疫功能等,但目前对于肠促胰素在脓毒症中的研究还很有限。在这个小型的回顾性研究中,作者利用医学主题词"肠促胰素"、"胰高血糖素样肽-1"、"抑胃肽"、"炎症和脓毒症"在PubMed进行检索。临床前研究模型和临床试验的结果提示,基于肠促胰素的疗法可以改善免疫功能、有效控制血糖、降低器官功能障碍的发生率和死亡率,但仍需要设计进一步的临床研究来观察脓毒症人群中肠促胰素的作用。综上所述,肠促胰素激素轴可以给临床医师提供思路,以期寻找到既能维持血糖平稳又可减轻炎症反应和改善临床结果的方法。

An article entitled"Therapeutic Effects of Endogenous Icretin Hormones and Exogenous Incretin-Based Medications in Sepsis"was published in November 2019 in JCEM[Faraaz AS,Hussain M,Teresa GM,et al.J Clin Endocrinol Metab,2019,104(11):5274-5284].We translated this article into Chinese after obtaining the copyright from the journal.Sepsis is currently defined as a life-threatening organ dysfunction caused by a host′s dysregulation of infection which can increase the risk of organ dysfunction and death if combined with abnormal blood glucose.For that reason,the authors believe that there is a need to find new targets for the treatment of sepsis and maintenance of blood glucose homeostasis.Incretin can regulate various functions,including islet hormone secretion,blood glucose concentration,lipid metabolism,intestinal motility,appetite,body weight,immune function,and so on.Nowadays the research on incretin in sepsis is still limited.The authors utilized the medical keywords"incretin","glucagon-like peptide-1","gastric inhibitory peptide","inflammation"and"sepsis"for Pubmed search in this small retrospective study.The results of preclinical research models and clinical trials suggest that incretin-based therapies can improve immune function,control blood glucose effectively and reduce the incidence and mortality of organ dysfunction.However,the authors believe that further clinical studies are still needed to observe the effects of incretin on sepsis.In summary,there is probably a way to maintain blood glucose homeostasis while reducing inflammation and improving clinical outcomes if the incretin hormone axis in sepsis is brought to attention.