持续炎症–免疫抑制–分解代谢综合征的免疫代谢与分层干预

Immunometabolism and Stratified Interventions in Persistent Inflammation, Immunosuppression, and Catabolism Syndrome

摘要: 持续炎症–免疫抑制–分解代谢综合征是部分危重症患者在急性期存活后向慢性危重症转归的重要病理生理状态，其本质并非单纯炎症迁延，而是持续炎症、免疫恢复障碍与高分解代谢相互耦联的免疫代谢失衡。近年来，关于该综合征的研究重点已由概念描述逐渐转向操作性识别和分层干预。现有证据显示，第7天更适合识别高风险轨迹，第14天更适合作为临床拟诊的关键时间点；炎症、免疫抑制、分解代谢及持续器官功能障碍应纳入统一评估框架。机制上，异常紧急髓系生成、髓源抑制细胞扩增、单核细胞抗原递呈受损、T细胞代谢重编程及线粒体功能障碍共同构成核心病理环路，肠道屏障破坏、凝血–内皮异常及神经内分泌应激可进一步放大这一过程。临床管理应以感染控制、营养支持和早期康复为基础，并在动态分层前提下审慎选择免疫调节及减负荷策略。未来研究亟需建立可重复的动态分层标准，筛选具有临床转化价值的生物标志物，并将长期功能恢复作为关键评价终点。

Abstract: Persistent inflammation, immunosuppression, and catabolism syndrome is an important pathophysiological state underlying the transition from acute critical illness to chronic critical illness in a subset of survivors. Rather than representing unresolved inflammation alone, it is characterized by immunometabolic disequilibrium driven by the interaction of persistent inflammation, impaired immune recovery, and sustained hypercatabolism. Recent research has shifted from conceptual description to operational identification and stratified intervention. Available evidence suggests that day 7 in the ICU is more suitable for early recognition of high-risk trajectories, whereas day 14 is a more practical time point for clinical identification. A multidimensional framework integrating inflammation, immunosuppression, catabolism, and persistent organ dysfunction is therefore required. Mechanistically, aberrant emergency myelopoiesis, expansion of myeloid-derived suppressor cells, impaired monocyte antigen presentation, T-cell metabolic reprogramming, and mitochondrial dysfunction constitute the central pathological loop, while gut barrier disruption, coagulation-endothelial dysregulation, and neuroendocrine stress may further amplify this process. Clinical management should prioritize infection control, nutritional support, and early rehabilitation, with immunomodulatory and load-reduction strategies applied cautiously on the basis of dynamic stratification. Future studies should focus on reproducible stratification criteria, clinically translatable biomarkers, and long-term functional recovery as a key endpoint.