脓毒症生物标志物研究进展

Research progress on the biomarkers of sepsis

脓毒症是宿主对感染反应失调而导致的危及生命的器官功能障碍,严重威胁人类生存。目前对于脓毒症的诊断主要依靠患者的临床特征,故积极寻找其有效的生物标志物不仅有助于早期识别,还可以进行早期干预,从而改善脓毒症患者预后,并降低其病死率,具有重要临床意义。研究表明,降钙素原(PCT)虽然可以指导临床抗菌药物的使用,但其不能作为脓毒症诊断的特异性生物标志物。有文献报道,抑癌蛋白M(OSM)、巨噬细胞凋亡抑制蛋白(AIM/CD5L)、白细胞介素(IL)-26、IL-17D作为炎症调节因子,在感染或炎症性疾病中发挥促炎作用,其在脓毒症患者血清中水平明显升高。IL-37、生长分化因子-15(GDF-15)是具有抗炎特性的炎症因子,在脓毒症患者血清中表达升高,但并未发挥其保护作用。这些炎症因子均可以作为脓毒症死亡风险的预测因子,而且OSM、IL-17D、AIM/CD5L似乎还可以作为脓毒症的潜在治疗靶点。然而到目前为止,尚没有发现很好的生物标志物具有足够的敏感性和特异性来帮助早期识别脓毒症。本文就脓毒症生物标志物的最新研究进展进行综述。

Sepsis is life-threatening organ dysfunction caused by a dysregulated host response to infection,which is still a serious threat to human survival.At present,the diagnosis of sepsis mainly depends on the clinical characteristics of patients.Therefore,actively looking for its effective biomarkers can not only help early identification,but also early intervention,so as to improve the prognosis of patients with sepsis and reduce their mortality.Studies have shown that although procalcitonin(PCT)can guide the use of clinical antibiotics,it can not be used as a specific biomarker for the diagnosis of sepsis.It has been reported that oncostatin M(OSM),apoptosis inhibitor of macrophage(AIM/CD5L),interleukin-26(IL-26)and interleukin-17D(IL-17D)as inflammatory regulators play a pro-inflammatory role in infection or inflammatory diseases,and their levels are significantly increased in the serum of patients with sepsis.Interleukin-37(IL-37)and growth differentiation factor-15(GDF-15)are inflammatory factors with anti-inflammatory properties.Their expression is increased in the serum of patients with sepsis,but they do not play a protective role.These inflammatory factors can be used as predictors of sepsis mortality,and OSM,IL-17D and AIM/CD5L seem to be potential therapeutic targets for sepsis.However,so far,no good biomarkers have been found with sufficient sensitivity and specificity to help early identification of sepsis.In this paper,we review the update progress about the biomarkers for sepsis.