脓毒症相关弥漫性血管内凝血研究进展

Research Progress in Sepsis-Induced Disseminated Intravascular Coagulation

摘要: 弥散性血管内凝血已被认为是脓毒症的致命性并发症，早期发现并对潜在感染进行适当的处理是目前的治疗策略。炎症、凝血等途径的激活是宿主抗感染的基本反应，但也会对宿主产生损伤。最近的研究进展有助于确定血栓形成在克服感染中的关键作用。除了病原体诱导的凝血激活外，脓毒症诱导DIC的发病机制还涉及损伤相关分子模式、中性粒细胞细胞外陷阱、细胞外囊泡、糖萼损伤等重要途径。而对于脓毒症相关弥散性血管内凝血的诊断也进行了不断更新简化，并发现某些生物标志物存在诊断价值，可以提高早期诊断率。在DIC中，治疗潜在原因是至关重要的，额外的辅助治疗包括抗凝血酶、凝血调节素和肝素可能有潜在的获益，但在改善临床相关结果方面仍然存在争议，缺失支持其使用的证据。本篇叙述性综述将从脓毒症相关DIC的流行病、发病机制、诊断、生物标志物及治疗等方面的研究进展进行论述，为进一步研究脓毒症相关弥散性血管内凝血，降低脓毒症患者并发症率及死亡率提供理论基础。

Abstract: Disseminated intravascular coagulation has been recognized as a fatal complication of sepsis, and early detection and appropriate management of potential infection is the current treatment strat-egy. The activation of inflammation, coagulation and other pathways is the basic anti-infection re-sponse of the host, but it can also cause damage to the host. Recent advances in research have con-tributed to identify the key role of thrombosis in overcoming infection. In addition to patho-gen-induced coagulation activation, the pathogenesis of DIC induced by sepsis also involves im-portant pathways such as damaged-associated molecular patterns, neutrophil extracellular traps, extracellular vesicles, and glycocalyx injury. Moreover, the diagnosis of sepsis induced disseminated intravascular coagulation has been constantly updated and simplified, and some biomarkers have been found to have diagnostic value, which can improve the early diagnosis rate. Treatment of un-derlying causes is critical in DIC, and additional adjuvant therapies including antithrombin, throm-bin, and heparin may have potential benefits, but their improvement in clinically relevant out-comes remains controversial and evidence to support their use is missing. This narrative review will discuss the research progress in the epidemiology, pathogenesis, diagnosis, biomarkers, treat-ment and other aspects of sepsis related DIC, so as to provide a theoretical basis for further research on sepsis induced disseminated intravascular coagulation and for reducing the complication rate and mortality of sepsis patients.