从Phoenix标准到精准医疗：儿童脓毒症器官 功能障碍的评估、机制与治疗策略研究进展

From Phoenix Criteria to Precision Medicine: Advances in the Assessment, Mechanisms, and Treatment Strategies for Organ Dysfunction in Pediatric Sepsis

摘要: 儿童脓毒症作为全球范围内导致儿童死亡及远期不良预后的核心病因，其本质为感染诱发宿主免疫应答失控，进而引发危及生命的序贯性器官功能损害。近年来，随着对该综合征病理本质认知的深化，其临床定义与评估体系经历了关键性变革，尤其是2024年国际共识所提出的Phoenix标准，标志着儿童特异性生理特征在评估框架中获得了更精准的体现。本文系统梳理了儿童脓毒症器官功能障碍评估工具从传统标准到Phoenix标准的演进历程，深入解析了其背后复杂的病理生理机制，包括免疫炎症失衡、内皮损伤、代谢功能障碍及器官间交互作用。在此基础上，综述了当前以器官支持为基础的综合治疗策略，并重点探讨了精准医疗范式下，基于生物标志物、多组学技术和人工智能的个体化治疗新方向。最后，分析了当前临床转化面临的挑战，并对未来整合动态监测与分子分型的精准干预体系提出了展望。

Abstract: Pediatric sepsis remains a leading cause of mortality and long-term adverse outcomes in children worldwide. Its core pathogenesis involves a dysregulated host immune response to infection, culminating in life-threatening sequential organ dysfunction. In recent years, advancements in understanding the pathological nature of this syndrome have driven critical evolutions in its clinical definition and assessment systems. Notably, the Phoenix criteria, proposed by the international consensus in 2024, signify a more precise incorporation of pediatric-specific physiological characteristics into the evaluation framework. This review systematically outlines the progression of assessment tools for pediatric sepsis-associated organ dysfunction, from traditional paradigms to the Phoenix criteria. It provides an in-depth analysis of the underlying complex pathophysiological mechanisms, encompassing immune-inflammatory imbalance, endothelial injury, metabolic dysfunction, and inter-organ crosstalk. Building on this foundation, the review synthesizes current comprehensive treatment strategies centered on organ support, with a focused discussion on emerging directions in individualized therapy under the precision medicine paradigm, leveraging biomarkers, multi-omics technologies, and artificial intelligence. Finally, it analyzes the key challenges hindering the clinical translation of these advancements and offers perspectives on developing a future precision intervention system that integrates dynamic monitoring with molecular phenotyping.