| 摘要: |
| 脓毒症是由感染引起的器官功能障碍，常伴随免疫功能失调，其特征为早期过度炎症反应与后期免疫抑制。由于免疫抑制，脓毒症患者在初次感染得到控制或缓解后容易发生新的感染，即二次感染。脓毒症二次感染会加重患者病程，延长住院时间，增加死亡风险，近年来逐渐受到临床关注。脓毒症诱导的免疫抑制是二次感染发生的核心因素，特别是在脓毒症后期，患者T细胞功能受损、自然杀伤细胞活性降低、巨噬细胞吞噬能力减弱，导致免疫监视能力下降。此外，脓毒症二次感染病原体存在免疫逃逸机制，增加了治疗难度。本文综述了脓毒症二次感染的免疫抑制机制及其临床意义，为优化救治方案提供参考。 |
| 关键词: 脓毒症 免疫抑制 二次感染 免疫监视 免疫逃逸 调节性T细胞 |
| DOI：10.16781/j.CN31-2187/R.20240861 |
| 投稿时间：2024-12-23修订日期：2025-04-09 |
| 基金项目:上海市科技创新行动计划基础研究领域项目（22JC1403600），军队临床重点专科-急诊重症医学科项目（JDLCZDZK-LWF）. |
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| Immunosuppressive mechanism of secondary infection in sepsis: research progress |
| FENG Wei,ZHANG Danying,WANG Yanan,LI Wenfang* |
(Department of Emergency and Critical Care Medicine, The Second Affiliated Hospital of Naval Medical University (Second Military Medical University), Shanghai 200003, China
*Corresponding author) |
| Abstract: |
| Sepsis is an organ dysfunction caused by a dysregulated host response to infection, often characterized by immune dysfunction. This condition typically manifests as an excessive inflammatory response at early stages, followed by immunosuppression at later stages. Due to this immunosuppressive state, patients with sepsis are susceptible to new infections, termed secondary infections, even after the primary infection has been controlled or resolved. In recent years, secondary infections in sepsis have garnered increasing clinical attention due to their risks to exacerbate the disease course, prolong hospital stay, and increase mortality risk. The sepsis-induced immunosuppression is central to the development of secondary infections, especially at the later stage of sepsis. Specifically, T cell function becomes impaired, natural killer cell activity decreases, and macrophage phagocytic ability weakens, all contributing to diminished immune surveillance. Additionally, the immune evasion mechanisms employed by pathogens responsible for secondary infections further complicate treatment. This review aims to elucidate the mechanisms of immunosuppression and its clinical significance in sepsis-related secondary infections, providing a guidance for optimizing treatment strategies. |
| Key words: sepsis immunosuppression secondary infection immune surveillance immune escape regulatory T cells |
