脓毒症相关免疫性血栓形成的相关机制及治疗研究进展
Research Progress on the Related Mechanisms and Treatments of Immune Thrombosis in Sepsis
DOI: 10.12677/acm.2026.161224, PDF,   
作者: 马宇昊, 牛亚军:西安医学院研究生工作部,陕西 西安;王 义*:西安交通大学附属儿童医院儿童重症医学科,陕西 西安
关键词: 免疫血栓形成脓毒症信号级联反应中性粒细胞外诱捕网弥散性血管内凝血Immune Thrombosis Sepsis Signal Cascade Neutrophil Extracellular Traps Disseminated Intravascular Coagulation
摘要: 脓毒症仍是目前重要的全球健康问题,其特征为因机体感染后引起的免疫失调而引起的危及生命的器官功能障碍。免疫性血栓是在免疫系统激活和机体凝血途径的双重影响下形成的,虽然其作为为机体正常生理条件下的防御机制,但其在脓毒症中的异常激活会促使微血管血栓形成,引起器官缺血,最终引起弥散性血管内凝血的发生。本文通过对现有相关文献的综述,总结了脓毒症发生免疫性血栓形成的相关机制及治疗研究进展。
Abstract: Sepsis remains a major global health concern at present, characterized by life-threatening organ dysfunction caused by immune dysregulation secondary to infection in the body. Immune thrombosis is formed under the dual influence of immune system activation and the body’s coagulation pathways. Although it acts as a defensive mechanism under normal physiological conditions, its abnormal activation during sepsis can promote the formation of microvascular thrombosis, induce organ ischemia, and ultimately lead to the development of disseminated intravascular coagulation (DIC). By reviewing the existing relevant literature, this paper summarizes the research progress on the related mechanisms and treatments of immune thrombosis in sepsis.
文章引用:马宇昊, 牛亚军, 王义. 脓毒症相关免疫性血栓形成的相关机制及治疗研究进展[J]. 临床医学进展, 2026, 16(1): 1761-1769. https://doi.org/10.12677/acm.2026.161224

参考文献

[1] Gyawali, B., Ramakrishna, K. and Dhamoon, A.S. (2019) Sepsis: The Evolution in Definition, Pathophysiology, and Management. Sage Open Medicine, 7, Article 2050312119835043. [Google Scholar] [CrossRef] [PubMed]
[2] Singer, M., Deutschman, C.S., Seymour, C.W., Shankar-Hari, M., Annane, D., Bauer, M., et al. (2016) The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). Journal of the American Medical Association, 315, 801-810. [Google Scholar] [CrossRef] [PubMed]
[3] 宋立成, 韩志海. 脓毒症相关凝血功能障碍机制及治疗的研究进展[J]. 中华危重症医学杂志(电子版), 2017, 10(2): 125-129.
[4] Tang, D., Wang, H., Billiar, T.R., Kroemer, G. and Kang, R. (2021) Emerging Mechanisms of Immunocoagulation in Sepsis and Septic Shock. Trends in Immunology, 42, 508-522. [Google Scholar] [CrossRef] [PubMed]
[5] Zhang, X., Zhang, Y., Yuan, S. and Zhang, J. (2024) The Potential Immunological Mechanisms of Sepsis. Frontiers in Immunology, 15, Article 1434688. [Google Scholar] [CrossRef] [PubMed]
[6] Jarczak, D. and Nierhaus, A. (2022) Cytokine Storm—Definition, Causes, and Implications. International Journal of Molecular Sciences, 23, Article 11740. [Google Scholar] [CrossRef] [PubMed]
[7] Hadid, T., Kafri, Z. and Al-Katib, A. (2021) Coagulation and Anticoagulation in Covid-19. Blood Reviews, 47, Article 100761. [Google Scholar] [CrossRef] [PubMed]
[8] Tsantes, A.G., Parastatidou, S., Tsantes, E.A., Bonova, E., Tsante, K.A., Mantzios, P.G., et al. (2023) Sepsis-Induced Coagulopathy: An Update on Pathophysiology, Biomarkers, and Current Guidelines. Life, 13, Article 350. [Google Scholar] [CrossRef] [PubMed]
[9] Chapin, J.C. and Hajjar, K.A. (2015) Fibrinolysis and the Control of Blood Coagulation. Blood Reviews, 29, 17-24. [Google Scholar] [CrossRef] [PubMed]
[10] Iba, T., Umemura, Y., Wada, H. and Levy, J.H. (2021) Roles of Coagulation Abnormalities and Microthrombosis in Sepsis: Pathophysiology, Diagnosis, and Treatment. Archives of Medical Research, 52, 788-797. [Google Scholar] [CrossRef] [PubMed]
[11] Iba, T., Helms, J., Neal, M.D. and Levy, J.H. (2023) Mechanisms and Management of the Coagulopathy of Trauma and Sepsis: Trauma-Induced Coagulopathy, Sepsis-Induced Coagulopathy, and Disseminated Intravascular Coagulation. Journal of Thrombosis and Haemostasis, 21, 3360-3370. [Google Scholar] [CrossRef] [PubMed]
[12] Maneta, E., Aivalioti, E., Tual-Chalot, S., Emini Veseli, B., Gatsiou, A., Stamatelopoulos, K., et al. (2023) Endothelial Dysfunction and Immunothrombosis in Sepsis. Frontiers in Immunology, 14, Article 1144229. [Google Scholar] [CrossRef] [PubMed]
[13] Wu, R., Wang, N., Comish, P.B., Tang, D. and Kang, R. (2021) Inflammasome-Dependent Coagulation Activation in Sepsis. Frontiers in Immunology, 12, Article 641750. [Google Scholar] [CrossRef] [PubMed]
[14] Ito, T., Kakuuchi, M. and Maruyama, I. (2021) Endotheliopathy in Septic Conditions: Mechanistic Insight into Intravascular Coagulation. Critical Care, 25, Article No. 95. [Google Scholar] [CrossRef] [PubMed]
[15] Eliwan, H., Omer, M., McKenna, E., Kelly, L.A., Nolan, B., Regan, I., et al. (2021) Protein C Pathway in Paediatric and Neonatal Sepsis. Frontiers in Pediatrics, 9, Article 562495. [Google Scholar] [CrossRef] [PubMed]
[16] Iba, T., Helms, J. and Levy, J.H. (2024) Sepsis-Induced Coagulopathy (SIC) in the Management of Sepsis. Annals of Intensive Care, 14, Article No. 148. [Google Scholar] [CrossRef] [PubMed]
[17] Zhang, H., Wang, Y., Qu, M., Li, W., Wu, D., Cata, J.P., et al. (2023) Neutrophil, Neutrophil Extracellular Traps and Endothelial Cell Dysfunction in Sepsis. Clinical and Translational Medicine, 13, e1170. [Google Scholar] [CrossRef] [PubMed]
[18] Cox, D. (2023) Sepsis—It Is All about the Platelets. Frontiers in Immunology, 14, Article 1210219. [Google Scholar] [CrossRef] [PubMed]
[19] Kratofil, R.M., Kubes, P. and Deniset, J.F. (2017) Monocyte Conversion during Inflammation and Injury. Arteriosclerosis, Thrombosis, and Vascular Biology, 37, 35-42. [Google Scholar] [CrossRef] [PubMed]
[20] Sachetto, A.T.A. and Mackman, N. (2023) Monocyte Tissue Factor Expression: Lipopolysaccharide Induction and Roles in Pathological Activation of Coagulation. Thrombosis and Haemostasis, 123, 1017-1033. [Google Scholar] [CrossRef] [PubMed]
[21] Mussbacher, M., Derler, M., Basílio, J. and Schmid, J.A. (2023) NF-κB in Monocytes and Macrophages—An Inflammatory Master Regulator in Multitalented Immune Cells. Frontiers in Immunology, 14, Article 1134661. [Google Scholar] [CrossRef] [PubMed]
[22] Xue, H., Xiao, Z., Zhao, X., Li, S., Cheng, Q., Fu, C., et al. (2024) CMTM3 Regulates Neutrophil Activation and Aggravates Sepsis through TLR4 Signaling. EMBO Reports, 25, 5456-5477. [Google Scholar] [CrossRef] [PubMed]
[23] Zhang, X. and Li, X. (2022) The Role of Histones and Heparin in Sepsis: A Review. Journal of Intensive Care Medicine, 37, 319-326. [Google Scholar] [CrossRef] [PubMed]
[24] Zhou, Y., Xu, Z. and Liu, Z. (2022) Impact of Neutrophil Extracellular Traps on Thrombosis Formation: New Findings and Future Perspective. Frontiers in Cellular and Infection Microbiology, 12, Article 910908. [Google Scholar] [CrossRef] [PubMed]
[25] Poli, V. and Zanoni, I. (2023) Neutrophil Intrinsic and Extrinsic Regulation of Netosis in Health and Disease. Trends in Microbiology, 31, 280-293. [Google Scholar] [CrossRef] [PubMed]
[26] Zhang, H., Zhou, Y., Qu, M., Yu, Y., Chen, Z., Zhu, S., et al. (2021) Tissue Factor-Enriched Neutrophil Extracellular Traps Promote Immunothrombosis and Disease Progression in Sepsis-Induced Lung Injury. Frontiers in Cellular and Infection Microbiology, 11, Article 677902. [Google Scholar] [CrossRef] [PubMed]
[27] Dimitrov, J.D., Roumenina, L.T., Perrella, G. and Rayes, J. (2023) Basic Mechanisms of Hemolysis-Associated Thrombo-Inflammation and Immune Dysregulation. Arteriosclerosis, Thrombosis, and Vascular Biology, 43, 1349-1361. [Google Scholar] [CrossRef] [PubMed]
[28] Adelborg, K., Larsen, J.B. and Hvas, A. (2021) Disseminated Intravascular Coagulation: Epidemiology, Biomarkers, and Management. British Journal of Haematology, 192, 803-818. [Google Scholar] [CrossRef] [PubMed]
[29] Giustozzi, M., Ehrlinder, H., Bongiovanni, D., Borovac, J.A., Guerreiro, R.A., Gąsecka, A., et al. (2021) Coagulopathy and Sepsis: Pathophysiology, Clinical Manifestations and Treatment. Blood Reviews, 50, Article 100864. [Google Scholar] [CrossRef] [PubMed]
[30] Kral-Pointner, J.B., Haider, P., Szabo, P.L., Salzmann, M., Brekalo, M., Schneider, K.H., et al. (2024) Reduced Monocyte and Neutrophil Infiltration and Activation by P-Selectin/CD62P Inhibition Enhances Thrombus Resolution in Mice. Arteriosclerosis, Thrombosis, and Vascular Biology, 44, 954-968. [Google Scholar] [CrossRef] [PubMed]
[31] Deppermann, C. and Kubes, P. (2016) Platelets and Infection. Seminars in Immunology, 28, 536-545. [Google Scholar] [CrossRef] [PubMed]
[32] Wienkamp, A., Erpenbeck, L. and Rossaint, J. (2022) Platelets in the Networks Interweaving Inflammation and Thrombosis. Frontiers in Immunology, 13, Article 953129. [Google Scholar] [CrossRef] [PubMed]
[33] Cong, X. and Kong, W. (2020) Endothelial Tight Junctions and Their Regulatory Signaling Pathways in Vascular Homeostasis and Disease. Cellular Signalling, 66, Article 109485. [Google Scholar] [CrossRef] [PubMed]
[34] Drummer, C.T., Saaoud, F., Shao, Y., Sun, Y., Xu, K., Lu, Y., et al. (2021) Trained Immunity and Reactivity of Macrophages and Endothelial Cells. Arteriosclerosis, Thrombosis, and Vascular Biology, 41, 1032-1046. [Google Scholar] [CrossRef] [PubMed]
[35] Tang, F., Zhao, X.L., Xu, L.Y., et al. (2024) Endothelial Dysfunction: Pathophysiology and Therapeutic Targets for Sepsis-Induced Multiple Organ Dysfunction Syndrome. Biomedicine & Pharmacotherapy, 178, Article 117180. [Google Scholar] [CrossRef] [PubMed]
[36] Joffre, J., Hellman, J., Ince, C. and Ait-Oufella, H. (2020) Endothelial Responses in Sepsis. American Journal of Respiratory and Critical Care Medicine, 202, 361-370. [Google Scholar] [CrossRef] [PubMed]
[37] Lehner, G.F., Tobiasch, A.K., Perschinka, F., Mayerhöfer, T., Waditzer, M., Haller, V., et al. (2024) Associations of Tissue Factor and Tissue Factor Pathway Inhibitor with Organ Dysfunctions in Septic Shock. Scientific Reports, 14, Article No. 14468. [Google Scholar] [CrossRef] [PubMed]
[38] Saavedra-Torres, J.S., Pinzón-Fernández, M.V., Ocampo-Posada, M., Nati-Castillo, H.A., Jiménez Hincapie, L.A., Cadrazo-Gil, E.J., et al. (2025) Inflammasomes and Signaling Pathways: Key Mechanisms in the Pathophysiology of Sepsis. Cells, 14, Article 930. [Google Scholar] [CrossRef] [PubMed]
[39] Shi, J., Tang, Y., Liang, F., Liu, L., Liang, N., Yang, X., et al. (2022) NLRP3 Inflammasome Contributes to Endotoxin-Induced Coagulation. Thrombosis Research, 214, 8-15. [Google Scholar] [CrossRef] [PubMed]
[40] Yang, X., Cheng, X., Tang, Y., Qiu, X., Wang, Y., Kang, H., et al. (2019) Bacterial Endotoxin Activates the Coagulation Cascade through Gasdermin D-Dependent Phosphatidylserine Exposure. Immunity, 51, 983-996.e6. [Google Scholar] [CrossRef] [PubMed]
[41] Mun, Y., Kim, J., Choi, Y. and Lee, B. (2025) cGAS-STING-NF-κB Axis Mediates Rotenone-Induced NLRP3 Inflammasome Activation through Mitochondrial DNA Release. Antioxidants, 14, Article 1276. [Google Scholar] [CrossRef
[42] Liu, Z., Bai, Y., Xu, B., Wen, H., Chen, K., Lin, J., et al. (2025) TDP43 Augments Astrocyte Inflammatory Activity through mtDNA-cGAS-STING Axis in NMOSD. Journal of Neuroinflammation, 22, Article No. 14. [Google Scholar] [CrossRef] [PubMed]
[43] Luo, X., Zhao, Y., Luo, Y., Lai, J., Ji, J., Huang, J., et al. (2024) Cytosolic mtDNA-cGAS-STING Axis Contributes to Sepsis-Induced Acute Kidney Injury via Activating the NLRP3 Inflammasome. Clinical and Experimental Nephrology, 28, 375-390. [Google Scholar] [CrossRef] [PubMed]
[44] Rathinam, V.A.K., Jiang, Z., Waggoner, S.N., Sharma, S., Cole, L.E., Waggoner, L., et al. (2010) The AIM2 Inflammasome Is Essential for Host Defense against Cytosolic Bacteria and DNA Viruses. Nature Immunology, 11, 395-402. [Google Scholar] [CrossRef] [PubMed]
[45] Xu, J., Gao, C., He, Y., Fang, X., Sun, D., Peng, Z., et al. (2023) NLRC3 Expression in Macrophage Impairs Glycolysis and Host Immune Defense by Modulating the NF-κB-NFAT5 Complex during Septic Immunosuppression. Molecular Therapy, 31, 154-173. [Google Scholar] [CrossRef] [PubMed]
[46] Ding, C., Song, Z., Shen, A., Chen, T. and Zhang, A. (2020) Small Molecules Targeting the Innate Immune cGAS-STING-TBK1 Signaling Pathway. Acta Pharmaceutica Sinica B, 10, 2272-2298. [Google Scholar] [CrossRef] [PubMed]
[47] Guidetti, G.F., Canobbio, I. and Torti, M. (2015) PI3K/Akt in Platelet Integrin Signaling and Implications in Thrombosis. Advances in Biological Regulation, 59, 36-52. [Google Scholar] [CrossRef] [PubMed]
[48] Pan, T., Sun, S., Chen, Y., Tian, R., Chen, E., Tan, R., et al. (2022) Immune Effects of PI3K/Akt/HIF-1α-Regulated Glycolysis in Polymorphonuclear Neutrophils during Sepsis. Critical Care, 26, Article no. 29. [Google Scholar] [CrossRef] [PubMed]
[49] Iba, T., Helms, J., Connors, J.M. and Levy, J.H. (2023) The Pathophysiology, Diagnosis, and Management of Sepsis-Associated Disseminated Intravascular Coagulation. Journal of Intensive Care, 11, Article No. 24. [Google Scholar] [CrossRef] [PubMed]
[50] Vagionas, D., Papadakis, D.D., Politou, M., Koutsoukou, A. and Vasileiadis, I. (2022) Thromboinflammation in Sepsis and Heparin: A Review of Literature and Pathophysiology. In Vivo, 36, 2542-2557. [Google Scholar] [CrossRef] [PubMed]
[51] Ebeyer-Masotta, M., Eichhorn, T., Weiss, R., Semak, V., Lauková, L., Fischer, M.B., et al. (2022) Heparin-Functionalized Adsorbents Eliminate Central Effectors of Immunothrombosis, Including Platelet Factor 4, High-Mobility Group Box 1 Protein and Histones. International Journal of Molecular Sciences, 23, Article 1823. [Google Scholar] [CrossRef] [PubMed]
[52] Li, X. and Ma, X. (2017) The Role of Heparin in Sepsis: Much More than Just an Anticoagulant. British Journal of Haematology, 179, 389-398. [Google Scholar] [CrossRef] [PubMed]
[53] Li, X., Zhang, G. and Cao, X. (2023) The Function and Regulation of Platelet P2Y12 Receptor. Cardiovascular Drugs and Therapy, 37, 199-216. [Google Scholar] [CrossRef] [PubMed]
[54] Morena, L., Cieri, I.F., Mendes, D.M., Suarez Ferreira, S.P., Patel, S., Ghandour, S., et al. (2025) The Impact of Platelets and Antiplatelets Medications on Immune Mediation. JVS-Vascular Science, 6, Article 100278. [Google Scholar] [CrossRef] [PubMed]
[55] Tobiasch, A.K., Lehner, G.F., Feistritzer, C., Peer, A., Zassler, B., Neumair, V.M., et al. (2024) Extracellular Vesicle Tissue Factor and Tissue Factor Pathway Inhibitor Are Independent Discriminators of Sepsis-Induced Coagulopathy. Research and Practice in Thrombosis and Haemostasis, 8, Article 102596. [Google Scholar] [CrossRef] [PubMed]
[56] Aoyama-Ishikawa, M., Higashi, H., Murakami, H., Inoue, T., Fujisaki, N. and Kohama, K. (2025) High Dose of Antithrombin Suppresses Neutrophil Extracellular Trap Formation in Human Neutrophils in Vitro Following Lipopolysaccharide-and Platelet-Induced Stimulation. Surgical Infections, 26, 762-769. [Google Scholar] [CrossRef
[57] Wang, M., Zhong, D., Dong, P. and Song, Y. (2018) Blocking CXCR1/2 Contributes to Amelioration of Lipopolysaccharide-Induced Sepsis by Downregulating Substance P. Journal of Cellular Biochemistry, 120, 2007-2014. [Google Scholar] [CrossRef] [PubMed]
[58] Okada, Y. (2024) Potential Therapeutic Strategies and Drugs That Target Vascular Permeability in Severe Infectious Diseases. Biological and Pharmaceutical Bulletin, 47, 549-555. [Google Scholar] [CrossRef] [PubMed]
[59] Zheng, Y., Zhang, X., Wang, Z., Zhang, R., Wei, H., Yan, X., et al. (2024) MCC950 as a Promising Candidate for Blocking NLRP3 Inflammasome Activation: A Review of Preclinical Research and Future Directions. Archiv der Pharmazie, 357, e2400459. [Google Scholar] [CrossRef] [PubMed]
[60] Xia, B.T., Beckmann, N., Winer, L.K., et al. (2019) Amitriptyline Reduces Inflammation and Mortality in a Murine Model of Sepsis. Cellular Physiology and Biochemistry, 52, 565-579.