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| 1 | 中国严重脓毒症/脓毒性休克治疗指南(2014)显示文摘脓毒症(sepsis)是由感染引起的全身炎症反应综合征(SIRS),可发展为严重脓毒症(severe sepsis)和脓毒性休克(septic shock)。严重脓毒症和脓毒性休克是重症医学面临的重要临床问题,随着人口的老龄化、肿瘤发病率上升以及侵入性医疗手段的增加,脓毒症的发病率在不断上升,每年全球新增数百万脓毒症患者,其中超过1/4的患者死亡[1-6]。中华医学会重症医学分会2007年组织编写了《成人严重脓毒症与脓毒性休克血流动力学监测与支持指南》,为脓毒症的诊治提供了规范和指导,但是随着近年来国内外该领域研究的不断深入,为了更好地指导我国重症医学工作者对严重脓毒症和脓毒性休克的治疗,中华医学会重症医学分会组织专家应用循证医学的方法制定了本指南。 | | 2015 | 中华危重病急救医学2015，27，6： | 403 |
| 2 | Treatment of severe acute pancreatitis and its complications显示文摘Severe acute pancreatitis(SAP),which is the most serious type of this disorder,is associated with high morbidity and mortality. SAP runs a biphasic course. During the first 1-2 wk,a pro-inflammatory response results in systemic inflammatory response syndrome(SIRS). If the SIRS is severe,it can lead to early multisystem organ failure(MOF). After the first 1-2 wk,a transition from a pro-inflammatory response to an anti-inflammatory response occurs;during this transition,the patient is at risk for intestinal flora translocation and the development of secondary infection of the necrotic tissue,which can result in sepsis and late MOF. Many recommendations have been made regarding SAP management and its complications. However,despite the reduction in overall mortality in the last decade,SAP is still associated with high mortality. In the majority of cases,sterile necrosis should be managed conservatively,whereas in infected necrotizing pancreatitis,the infected non-vital solid tissue should be removed to control the sepsis. Intervention should be delayed for as long as possible to allow better demarcation and liquefaction of the necrosis. Currently,the step-up approach(delay,drain,and debride) may be considered as the reference standard intervention for this disorder. | Enver Zerem | 2014 | World Journal of Gastroenterology2014，20，38： | 156 |
| 3 | 《2008国际严重脓毒症和脓毒性休克治疗指南》概要显示文摘2003年12月,参与“拯救脓毒症战役”(surviving sepsis campaign,SSC)行动的11个国际学术团体的44位专家,以近10年文献资料为基础,按照循证医学的基本原则,共同商讨和制定了《2004国际严重脓毒症和脓毒性休克治疗指南》,推荐了多达46条治疗建议。应该说这是当前关于脓毒症治疗方法最权威性的指导性意见, | 姚咏明 黄立锋 | 2008 | 中国危重病急救医学2008，20，3： | 79 |
| 4 | SIRS、sepsis、严重sepsis和MODS的诊断标准显示文摘 | 俞森洋 | 2009 | 临床肺科杂志2009，14，1： | 80 |
| 5 | Sepsis3.0对ICU脓毒症患者诊断及预后评估的验证显示文摘目的验证Sepsis3.0诊断标准下序贯器官衰竭评分(SOFA)、快速SOFA(qSOFA)对脓毒症患者的诊断及预后评估价值。方法回顾性分析2014年7月至2016年6月首都医科大学附属北京中医医院重症加强治疗病房(ICU)收治的脓毒症患者的临床资料,根据人院转归分为存活组与死亡组,收集患者性别、年龄、感染部位,以及患者人院时的呼吸频率(RR)、氧合指数(PaO2/FiO2)、格拉斯哥昏迷评分(GCS)、总胆红素(TBil)、血小板计数(PLT)、血肌酐(SCr)、血乳酸水平等一般资料,进行SOFA评分、qSOFA评分,筛选符合Sepsis3.0诊断标准的脓毒症患者作为SOFA组和qSOFA组。结果纳入的545例脓毒症患者中符合Sepsis3.0诊断标准者189例,其中SOFA组脓毒症发生率为34.68%,qSOFA组脓毒症发生率为15.96%,两组比较差异有统计学意义(P〈0.01);SOFA组病死率明显低于qSOFA组[28.04%(53/189)比42.53%(38/87),P〈0.05],qSOFA组病死率约为SOFA组的1.52倍。评分方面,死亡组患者SOFA评分明显高于存活组(分:8.74±0.42比7.10±0.23,P〈0.01);死亡组和存活组qSOFA评分比较差异无统计学意义(分:2.32±0.48比2.16±0.37,P〉0.05)。实验室指标方面,死亡组GCS评分明显低于存活组(分:8.15±0.67比12.48±0.36)、血乳酸水平高于存活组(mmol/L:8.55±4.66比2.31±0.16,P〈0.01);两组PaO2/FiO2、TBil、PLT、SCr比较差异均无统计学意义(均P〉0.05)。结论Sepsis5.0可用于ICU脓毒症患者的诊断,SOFA评分比qSOFA评分更适用于ICU脓毒症患者的诊断及预后评估;SOFA评分、GCS评分、血乳酸水平可用于评估脓毒症患者的预后。 | 宋麦芬 张羽 郭玉红 夏非 吴彦青 石筝筝 史清泉 陈腾飞 刘清泉 | 2017 | 中国中西医结合急救杂志2017，24，1： | 52 |
| 6 | 深化对血必净注射液治疗脓毒症新机制的认识显示文摘严重烧伤、创伤及外科大手术应激打击极易诱发脓毒症(sepsis)等感染并发症,进一步发展可导致脓毒性休克、多器官功能障碍综合征(MODS),是临床烧伤、创伤和危重患者最主要的死亡原因之一[1]。尽管早期液体复苏、新颖抗菌药物治疗、营养代谢及重要器官辅助性支持已取得长足进步,但严重脓毒症的病死率仍居高不下(30%~70%),成为直接影响患者预后、阻碍进一步提高急危重症救治成功率的世界性难题。因此,深化对脓毒症的认识和防治水平无疑具有重要的理论价值及临床意义。 | 姚咏明 | 2013 | 中国中西医结合急救杂志2013，20，4： | 49 |
| 7 | Pathophysiology of sepsis-induced myocardial dysfunction显示文摘Sepsis-induced myocardial dysfunction is a common complication in septic patients and is associated with increased mortality.In the clinical setting,it was once believed that myocardial dysfunction was not a major pathological process in the septic patients,at least in part,due to the unavailability of suitable clinical markers to assess intrinsic myocardial function during sepsis.Although sepsis-induced myocardial dysfunction has been studied in clinical and basic research for more than 30 years,its pathophysiology is not completely understood,and no specific therapies for this disorder exist.The purpose of this review is to summarize our current knowledge of sepsis-induced myocardial dysfunction with a special focus on pathogenesis and clinical characteristics. | Xiu-Xiu Lv Hua-Dong Wang | 2016 | Journal of Medical Colleges of PLA(China)2016，31，4： | 45 |
| 8 | 新生儿败血症诊断研究进展显示文摘2002年,欧美20余位儿科帕床、感染疾病、临床研究学者,对儿科脓毒症(sepsis)进行了重新定义。sepsis更新为感染加全身炎症反应综合征(SIRS)。而septicemia包含在sepsis中,临床上有时很难区分,给诊断治疗带来困难。2003年我国也重新修订了新生儿败血症诊断标准。 | 焦建成 余加林 | 2010 | 中华儿科杂志2010，48，1： | 30 |
| 9 | 脓毒症与炎性因子的研究进展显示文摘脓毒症(sepsis):指各种感染引起的全身炎症反应综合症,是感染性疾病常见的危重症,死亡率较高,脓毒症的发病是多重因素综合作用的结果,传统的观点认为脓毒症是由炎症反应过度所致。机体受到病原体感染时,病原体表面的抗原被机体炎症效应细胞表面的受体识别,并通过抗原、抗体反应及酶的活化途径,激活细胞内转录因子(如核因子NF-κB),并诱导多种促炎因子和炎性介质的生成及释放[1]。 | 薛庆亮 贾金虎 刘杜姣 | 2015 | 临床肺科杂志2015，20，2： | 29 |
| 10 | Bacterial infections in cirrhosis: A critical review and practical guidance显示文摘Bacterial infection is common and accounts for major morbidity and mortality in cirrhosis. Patients with cirrhosis are immunocompromised and increased susceptibility to develop spontaneous bacterial infections, hospital-acquired infections, and a variety of infections from uncommon pathogens. Once infection develops, the excessive response of pro-inflammatory cytokines on a pre-existing hemodynamic dysfunction in cirrhosis further predispose the development of serious complications such as shock, acute-on-chronic liver failure, renal failure, and death. Spontaneous bacterial peritonitis and bacteremia are common in patients with advanced cirrhosis, and are important prognostic landmarks in the natural history of cirrhosis. Notably, the incidence of infections from resistant bacteria has increased significantly in healthcare-associated settings. Serum biomarkers such as procalcitonin may help to improve the diagnosis of bacterial infection. Preventive measures(e.g., avoidance, antibiotic prophylaxis, and vaccination), early recognition, and proper management are required in order to minimize morbidity and mortality of infections in cirrhosis. | Chalermrat Bunchorntavakul Naichaya Chamroonkul Disaya Chavalitdhamrong | 2016 | World Journal of Hepatology2016，8，6： | 27 |
| 11 | Effects of early enteral nutrition on Th17/Treg cells and IL-23/IL-17 in septic patients显示文摘BACKGROUND The imbalance of Th17/Treg cells and the IL-23/IL-17 axis have been confirmed to be associated with sepsis and various inflammatory diseases. Early enteral nutrition (EEN) can modulate the inflammatory response, improve immune dysfunction, and prevent enterogenic infection in critically ill patients;however, the precise mechanisms remain unclear. Considering the important roles of Th17 and Treg lymphocytes in the development of inflammatory and infectious diseases, we hypothesized that EEN could improve the immune dysfunction in sepsis by maintaining a balanced Th17/Treg cell ratio and by regulating the IL- 23/IL-17 axis. AIM To investigate the effects of EEN on the Th17/Treg cell ratios and the IL-23/IL-17 axis in septic patients. METHODS In this prospective clinical trial, patients were randomly divided into an EEN or delayed enteral nutrition (DEN) group. Enteral feeding was started within 48 h in the EEN group, whereas enteral feeding was started on the 4th day in the DEN group. The Th17 and Treg cell percentages and the interleukin levels were tested on days 1, 3, and 7 after admission. The clinical severity and outcome variables were also recorded. RESULTS Fifty-three patients were enrolled in this trial from October 2017 to June 2018. The Th17 cell percentages, Th17/Treg cell ratios, IL-17, IL-23, and IL-6 levels of the EEN group were lower than those of the DEN group on the 7th day after admission (P < 0.05). The duration of mechanical ventilation and of the intensive care unit stay of the EEN group were shorter than those of the DEN group (P <0.05). However, no difference in the 28-d mortality was found between the two groups (P = 0.728). CONCLUSION EEN could regulate the imbalance of Th17/Treg cell ratios and suppress the IL- 23/IL-17 axis during sepsis. Moreover, EEN could reduce the clinical severity of sepsis but did not reduce the 28-d mortality of septic patients. | Jia-Kui Sun Wen-Hao Zhang Wen-Xiu Chen Xiang Wang Xin-Wei Mu | 2019 | World Journal of Gastroenterology2019，25，22： | 27 |
| 12 | Outcomes of severe sepsis and septic shock patients after stratifi cation by initial lactate value显示文摘BACKGROUND: In the setting of severe sepsis and septic shock, mortality increases when lactate levels are ≥ 4 mmol/L. However, the consequences of lower lactate levels in this population are not well understood. The study aimed to determine the in-hospital mortality associated with severe sepsis and septic shock when initial lactate levels are < 4 mmol/L.METHODS: This is a retrospective cohort study of septic patients admitted over a 40-month period. Totally 338 patients were divided into three groups based on initial lactate values. Group 1 had lactate levels < 2 mmol/L; group 2: 2–4 mmol/L; and group 3: ≥ 4 mmol/L. The primary outcome was in-hospital mortality.RESULTS: There were 111 patients in group 1, 96 patients in group 2, and 131 in group 3. The mortality rates were 21.6%, 35.4%, and 51.9% respectively. Univariate analysis revealed the mortality differences to be statistically significant. Multivariate logistic regression demonstrated higher odds of death with higher lactate tier group, however the findings did not reach statistical significance.CONCLUSION: This study found that only assignment to group 3, initial lactic acid level of ≥ 4 mmol/L, was independently associated with increased mortality after correcting for underlying severity of illness and organ dysfunction. However, rising lactate levels in the other two groups were associated with increased severity of illness and were inversely proportional to prognosis. | Kimberly A. Chambers Adam Y. Park Rosa C. Banuelos Bryan F. Darge Bindu H. Akkanti Annamaria Macaluso Manoj Thangam Pratik B. Doshi | 2018 | World Journal of Emergency Medicine2018，9，2： | 26 |
| 13 | 再论脓毒症的集束化治疗策略显示文摘 | 黄伟 万献尧 | 2009 | 中国呼吸与危重监护杂志2009，8，2： | 24 |
| 14 | Interplay between inflammation,immune system and neuronal pathways:Effect on gastrointestinal motility显示文摘Sepsis is a systemic inflammatory response representing the leading cause of death in critically ill patients,mostly due to multiple organ failure.The gastrointestinal tract plays a pivotal role in the pathogenesis of sepsisinduced multiple organ failure through intestinal barrier dysfunction,bacterial translocation and ileus.In this review we address the role of the gastrointestinal tract,the mediators,cell types and transduction pathways involved,based on experimental data obtained from models of inflammation-induced ileus and (preliminary) clinical data.The complex interplay within the gastrointestinal wall between mast cells,residential macrophages and glial cells on the one hand,and neurons and smooth muscle cells on the other hand,involves intracellular signaling pathways,Toll-like receptors and a plethora of neuroactive substances such as nitric oxide,prostaglandins,cytokines,chemokines,growth factors,tryptases and hormones.Multidirectional signaling between the different components in the gastrointestinal wall,the spinal cord and central nervous system impacts inflammation and its consequences.We propose that novel therapeutic strategies should target inflammation on the one hand and gastrointestinal motility,gas-trointestinal sensitivity and even pain signaling on the other hand,for instance by impeding afferent neuronal signaling,by activation of the vagal anti-inflammatory pathway or by the use of pharmacological agents such as ghrelin and ghrelin agonists or drugs interfering with the endocannabinoid system. | Benedicte Y De Winter Joris G De Man | 2010 | World Journal of Gastroenterology2010，16，44： | 23 |
| 15 | 可预测早发型新生儿败血症的脐血标志物显示文摘本综述阐述了在脐血中测得的C反应蛋白、降钙素原及多种细胞因子在预测早发型新生儿败血症(early-onset neonatal sepsis,EONS)中的应用。对于各个炎性标志物,我们将描述感染后该标志物在体内的动力学特点、产生该标志物的细胞、孕龄和脐血中该标志物初始浓度的关系、穿过胎盘的能力以及它们的统计学价值。 | 范颖 余加林 | 2012 | 儿科药学杂志2012，18，11： | 23 |
| 16 | Presepsin as a novel sepsis biomarker显示文摘BACKGROUND: In 2004, a new biomarker sCD14-subtypes(presepsin) was found and its value was shown in the diagnosis and evaluation of sepsis. This article is a brief overview of the new biomarker.DATA SOURCES: A literature search using multiple databases was performed for articles, especially meta-analyses, systematic reviews, and randomized controlled trials.RESULTS: Compared with other markers, presepsin seems to have a better sensitivity and specificity in the diagnosis of sepsis. Presepsin as a biom1 arker is not only suitable for the early diagnosis of sepsis, but also for the assessment of its severity and prognosis.CONCLUSIONS: Presepsin has a higher sensitivity and specificity in the diagnosis of sepsis as a new biomarker, and is a predictor for the prognosis of sepsis. More importantly, preseptin seems to play a crucial role as a supplemental method in the early diagnosis of sepsis. Since there is no multicenter study on the relationship between presepsin and sepsis, further studies on the clinical values of presepsin are needed. | Qi Zou Wei Wen Xin-chao Zhang | 2014 | World Journal of Emergency Medicine2014，5，1： | 23 |
| 17 | GSDMB promotes non-canonical pyroptosis by enhancing caspase-4 activity显示文摘Gasdermin B (GSDMB) has been reported to be associated with immune diseases in humans, but the detailed molecular mechanisms remain unsolved. The N-terminus of GSDMB by itself, unlike other gasdermin family proteins, does not induce cell death. Here, we show that GSDMB is highly expressed in the leukocytes of septic shock patients, which is associated with increased release of the gasdermin D (GSDMD) N-terminus. GSDMB expression and the accumulation of the N-terminal fragment of GSDMD are induced by the activation of the non-canonical pyroptosis pathway in a human monocyte cell line. The downregulation of GSDMB alleviates the cleavage of GSDMD and cell death. Consistently, the overexpression of GSDMB promotes GSDMD cleavage, accompanied by increased LDH release. We further found that GSDMB promotes caspase-4 activity, which is required for the cleavage of GSDMD in non-canonical pyroptosis, by directly binding to the CARD domain of caspase-4. Our study reveals a GSDMB-mediated novel regulatory mechanism for non-canonical pyroptosis and suggests a potential new strategy for the treatment of inflammatory diseases. | Qin Chen Peiliang Shi Yufang Wang Dayuan Zou Xiuwen Wu Dingyu Wang Qiongyuan Hu Yujie Zou Zan Huang Jianan Ren Zhaoyu Lin Xiang Gao | 2019 | Journal of Molecular Cell Biology2019，11，6： | 22 |
| 18 | Effect of neutrophil CD64 for diagnosing sepsis in emergency department显示文摘BACKGROUND:The aim of this study is to investigate the diagnostic and prognostic value of neutrophil CD64(nCD64)as a novel biomarker in sepsis patients.METHODS:One hundred fifty-one adult patients diagnosed with sepsis and 20 age-matched healthy controls were enrolled in the study.Patients with sepsis were further subdivided into a sepsis group and a septic shock group.nCD64 expression,serum procalcitonin(PCT)level,C-reactive protein(CRP)level,and white blood cell(WBC)count were obtained for each patient,and Sequential Organ Failure Assessment(SOFA)scores were calculated.RESULTS:nCD64 expression was higher in the sepsis group with confirmed infection than in the control group.The receiver operating characteristic(ROC)curve of nCD64 was higher than those of SOFA score,PCT,CRP and WBC for diagnosing infection.The area under the curve(AUC)of nCD64 combined with SOFA score was the highest for all parameters.The AUC of nCD64 for predicting 28-day mortality in sepsis was signifi cantly higher than those of PCT,CRP,and WBC,but slightly lower than that of SOFA score.The AUC of nCD64 or PCT combined with SOFA score was signifi cantly higher than that of any single parameter for predicting 28-day mortality.CONCLUSION:nCD64 expression and SOFA score are valuable parameters for early diagnosis of infection and prognostic evaluation of sepsis patients. | Wen-peng Yin Jia-bao Li Xiao-fang Zheng Le An Huan Shao Chun-sheng Li | 2020 | World Journal of Emergency Medicine2020，11，2： | 23 |
| 19 | Extracellular vesicle activities regulating macrophage- and tissue-mediated injury and repair responses显示文摘Macrophages are typically identified as classically activated(M1) macrophages and alternatively activated(M2) macrophages,which respectively exhibit pro-and anti-inflammatory phenotypes,and the balance between these two subtypes plays a critical role in the regulation of tissue inflammation,injury,and repair processes.Recent studies indicate that tissue cells and macrophages interact via the release of small extracellular vesicles(EVs) in processes where EVs released by stressed tissue cells can promote the activation and polarization of adjacent macrophages which can in turn release EVs and factors that can promote cell stress and tissue inflammation and injury and vice versa.This review discusses the roles of such EVs in resulating such interactions to influence tissue inflammation and injury in a number of acute and chronic inflammatory disease conditions,and the potential applications,advantage and concerns for using EV-based therapeutic approaches to treat such conditions,including their potential role of drug carriers for the treatment of infectious diseases. | Qian Hu Christopher J.Lyon Jesse K.Fletcher Wenfu Tang Meihua Wan Tony Y.Hu | 2021 | Acta Pharmaceutica Sinica B2021，11，6： | 22 |
| 20 | The role of regulatory T cells in immune dysfunction during sepsis显示文摘BACKGROUND: Although regulatory T cells(Tregs) are key to the maintenance of immunologic homeostasis and tolerance, little is known about Treg-mediated immunosuppression in the stage of sepsis. This article aimed to review the current literature on the role of Tregs in the pathophysiology of septic response, attempting to investigate the role of Tregs in immune dysfunction during sepsis.DATA SOURCES: A literature search was conducted in January 2014 using the China National Knowledge Infrastructure and Pub Med. Articles on the role of Tregs in immune dysfunction during sepsis were identified.RESULTS: The identified articles indicated that Treg levels can be used for the assessment of the course of sepsis. The inhibition of Treg activity can promote the recovery of immune function.CONCLUSION: Since the mechanism of Tregs is complex during the sepsis, more studies are needed. | Chao Cao Tao Ma Yan-fen Chai Song-tao Shou | 2015 | World Journal of Emergency Medicine2015，6，1： | 21 |
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