血管紧张素转化酶2在脓毒症性急性呼吸窘迫综合征中的研究进展

Research progress of angiotensin-converting enzyme-2 in septic acute respiratory distress syndrome

急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)是重症监护室常见临床综合征。脓毒症是感染引起宿主反应失调,导致危及生命的器官功能损害临床症候群。在脓毒症引起的微循环障碍中,肺泡-毛细血管膜结构作为局部微循环的重要构成部分极易受累。故脓毒症是ARDS最主要、最重要的诱发因素,且具有更高的死亡率和病死率。血管紧张素转化酶-2(angiotensin-converting enzyme-2,ACE-2)作为肾素-血管紧张素系统(renin-angiotensin system,RAS)的重要组成,具有保护内皮、调节炎性因子表达等功能,近年再一次受到额外关注。干预ACE-2能对ARDS及新冠肺炎的严重程度有一定影响,故ACE-2在脓毒症相关性ARDS中的作用值得讨论。本文总结了ACE-2本身的生物学特点及主要作用机制,讨论了ACE-2在脓毒症相关性ARDS中的可能作用,最后探讨了ACE-2对脓毒症相关性ARDS的病情评估及治疗意义,以期为临床治疗脓毒症相关性ARDS提供借鉴及启示。

Acute respiratory distress syndrome(ARDS) is a common clinical syndrome in intensive care unit. Sepsis is a clinical syndrome,which is with life-threatening organ function damage caused by infection. As an important part of local microcirculation,the structure of alveolar-capillary membrane is easily damaged in the course of sepsis. So sepsis is the most prime and important inducing factor of ARDS,and it has higher mortality and fatality. As an important constitution of renin-angiotensin system(RAS),angiotensin-converting enzyme-2(ACE-2) has the function of protecting endothelium and regulating the expression of inflammatory factors,so it has received additional attention in recent years. Through the intervention of ACE-2,ARDS and the severity of COVID-19 can be affected to a certain extent,so the role of ACE-2 in septic ARDS is worth discussing. This paper summarizes the biological characteristics and main mechanism of ACE-2,discusses the possible role of ACE-2 in septic ARDS,and finally explores the significance of ACE-2 in the evaluation and treatment of septic ARDS,in order to provide reference and inspiration for clinical treatment of sepsis-related ARDS.