脓毒症相关生物标志物的研究进展

Research progress of sepsis related biomarkers

脓毒症被定义为“由宿主对感染反应失调而导致的危及生命的器官功能障碍”。尽管脓毒症的治疗在过去几年中发展迅速,但临床治疗中脓毒症的发病率和病死率仍在攀升。此外,由于脓毒症的表现形式多样,临床医生在脓毒症患者的诊断、治疗和管理方面仍面临严峻挑战。文章综述了对脓毒症早期诊断或对疾病的严重程度及预后评估有潜在价值的生物标志物,包括传统的与感染相关的生物标志物:降钙素原、C反应蛋白、细胞因子等;与炎性反应激活和免疫失衡相关的生物标志物:钙卫蛋白、血清穿透素3、可溶性CD14亚型、中性粒细胞CD64、单核细胞趋化蛋白-1、肾上腺髓质素和肾上腺髓质素前体、可溶性髓样细胞触发受体-1、可溶性尿激酶型纤溶酶原激活剂受体、Toll样受体4、程序性死亡-1受体、可溶性肿瘤坏死因子1型受体等;与器官功能障碍相关的新型生物标志物:血管生成素-1和血管生成素-2、基质金属蛋白酶、MicroRNA、长链非编码RNA等。通过对上述标志物的总结,为优化脓毒症的诊断和治疗策略提供帮助。

According to the Third International Consensus Definitions for Sepsis and Septic Shock(Sepsis-3),sepsis is defined as“life-threatening organ dysfunction caused by the dysregulated host response to infection”.Although the treatment of sepsis has developed rapidly in the past few years,the incidence rate and mortality of sepsis in clinical treatment are still rising.In addition,due to the various manifestations of sepsis,clinicians still face severe challenges in the diagnosis,treatment and management of sepsis patients.Here,we review the biomarkers that have potential value for early diagnosis of sepsis or assessment of disease severity and prognosis,including 1 Traditional biomarkers related to infection:procalcitonin,C-reactive protein,cytokines,etc;2 Biomarkers related to inflammation activation and immune imbalance:calprotectin,pentraxin3,soluble CD14 subtype,CD64,monocyte chemoattractant protein-1,adrenomedullin and Pro-Adrenomedullin,soluble triggering receptor expressed on myeloid cell 1,soluble urokinase-type plasminogen activator receptor,toll like receptor 4,programmed death-1 receptor,soluble tumor necrosis factor-1 receptor,etc;3 New biomarkers related to organ dysfunction:angiopoietin-1 and angiopoietin-2,matrix metalloproteinase,microRNA,Long non-coding RNA,etc.It is hoped that the summary of the above markers will help to optimize the diagnosis and treatment strategies of sepsis and bring help to relevant research.