脓毒性心肌病发病机制研究进展

Research Progress of Pathogenesis of Sepsis Cardiomyopathy

脓毒症是人体对炎症反应失调引起机体系统或器官功能障碍,如果不能早期识别及时治疗,将导致休克、多器官功能衰竭,甚至死亡。具有高发病率、高病死率的特点,已成为急危重症患者死亡的第一大原因。脓毒性心肌病(sepsis cardio myopathy, SCM)是脓毒症引起的常见的并发症之一,导致可逆性的左心室收缩功能障碍,引起心输出量下降、休克、左心室扩张伴或不伴有右心衰竭,使脓毒症患者死亡率增加至70%~90%,是脓毒症患者主要死亡原因之一。目前,脓毒性心肌病的发病机制尚无统一阐述,但深入研究脓毒性心肌病的发病机制,发现其潜在的治疗靶点,可能会降低脓毒性心肌病患者的死亡率,为临床带来福音。脓毒性心肌病的发病机制多样且尚无统一阐述,本文将从氧化应激、线粒体自噬、钙稳态失衡、炎性细胞因子、一氧化氮、Toll样受体、免疫抑制等以上方面对脓毒性心肌病的发病机制进行综合论述。

Sepsis is a syndrome that causes life threatening organ dysfunction due to the host’s disorder of re-sponse to infection. If it is not recognized early and treated in time, it will lead to shock, multiple organ failure, and even death. It has the characteristics of high morbidity and high mortality and has become the first cause of death in critically ill patients. sepsis cardiomyopathy (SCM) is one of the common complications caused by sepsis, which leads to reversible left ventricular systolic dys-function, resulting in decreased cardiac output, shock, left ventricular dilatation, with or without right heart failure, and increasing the mortality rate of patients with sepsis to 70%~90%. It is one of the main causes of death in patients with sepsis. At present, there is no unified explanation of the pathogenesis of sepsis cardiomyopathy, but in-depth study of the pathogenesis of sepsis cardiomy-opathy and the discovery of its potential therapeutic targets may reduce the mortality of patients with sepsis cardiomyopathy and bring good news to the clinic. The pathogenesis of sepsis cardio-myopathy is diverse and there is no unified explanation. This article will comprehensively discuss the pathogenesis of sepsis cardiomyopathy from the aspects of oxidative stress, mitophagy, calcium homeostasis imbalance, inflammatory cytokines, nitric oxide, Toll-like receptors, immunosuppres-sion, etc.