 嗜酸性粒细胞在脓毒症和急性呼吸窘迫综合征中的作用：应用范围研究 贵州医科大学 高鸿教授课题组 翻译：任文鑫 编辑：佟睿 审校：曹莹 感染性休克和急性呼吸窘迫综合征（ARDS）的特点是机体免疫反应失调，可能对激素治疗有反应。嗜酸性粒细胞导致2型炎症，通常对类固醇治疗有反应；它们在脓毒症和ARDS的免疫失调和转归中的作用尚不清楚。 从开始到2020年9月9日，对Cochrane图书馆、MEDLINE和EMBASE进行了系统的搜索。搜索关键词是：嗜酸性粒细胞、败血症、败血症性休克和ARDS。两位评审员独立筛选了摘要和文本，并提取了有关疾病严重程度和临床结果的数据。 确定了39项研究：30项评估脓毒症患者的血清嗜酸性粒细胞计数，1项评估脓毒症患者的嗜酸性粒细胞活性，3项评估ARDS患者的支气管肺泡灌洗（BAL）嗜酸性粒细胞计数，4项评估ARDS患者的嗜酸性粒细胞活性，1项评估ARDS患者的外周嗜酸性粒细胞计数。11项研究显示嗜酸性粒细胞减少与脓毒症之间存在关联，8项研究发现在重症监护病房入院48小时后持续嗜酸性粒细胞减少可预测脓毒症患者的死亡率和再入院率。三项研究发现ARDS患者BAL嗜酸性粒细胞计数较低，但有一项研究发现ARDS晚期BAL嗜酸性粒细胞水平升高。三项研究发现，ARDS患者BAL中的嗜酸性粒细胞活性标志物较高，并与ARDS的严重程度相关。 持续性外周嗜酸性粒细胞减少是细菌性败血症的标志，与不良预后独立相关。支气管肺泡灌洗液中嗜酸性粒细胞计数在ARDS早期较低，但在ARDS晚期增加，而嗜酸性粒细胞活性标志物升高与ARDS严重程度相关。需要进一步研究脓毒症导致嗜酸性粒细胞减少和ARDS中嗜酸性粒细胞活性增加的机制。 Zainab Al Duhailib, Malik Farooqi, Joshua Piticaru,et al.The role of eosinophils in sepsis and acute respiratory distress syndrome: a scoping review.Can J Anesth/J Can Anesth (2021) 68:715–726. The role of eosinophils in sepsis and acute respiratory distress syndrome: a scoping review Purpose Septic shock and acute respiratory distress syndrome (ARDS) are characterized by a dysregulated immune host response that may respond to steroid therapy. Eosinophils contribute to type 2 inflammation that often responds to steroid therapy; their role in immune dysregulation and outcomes in sepsis and ARDS is unclear. Source A systematic search of Cochrane Library, MEDLINE, and EMBASE was performed from inception to 9 September 2020. The search comprised the following terms: eosinophils, sepsis, septic shock, and ARDS. Two reviewers independently screened abstracts and texts and extracted data on disease severity and clinical outcomes. Principal findings Thirty-nine studies were identified: 30 evaluated serum eosinophil count in sepsis, one evaluated eosinophil activity in sepsis, three assessed bronchoalveolar lavage (BAL) eosinophil count in ARDS, four assessed eosinophil activity in ARDS, and one assessed peripheral eosinophil count in ARDS. Eleven studies showed an association between eosinopenia and sepsis, and eight studies found persistent eosinopenia at>48 hr of intensive care unit admission to predict mortality and readmission in septic patients. Three studies found BAL eosinophil count to be low in ARDS, although one found that levels rose in late-phase ARDS. Three studies found eosinophil activity markers in BAL to be high in ARDS and correlate with ARDS severity. Conclusion Persistent peripheral eosinopenia is a marker of bacterial sepsis and is independently associated with poor outcomes. Bronchoalveolar lavage eosinophil count sare low in early-phase ARDS, but increase in late-phase ARDS, while elevated markers of eosinophil activity correlate with ARDS severity. Further studies understanding the mechanisms leading to eosinopenia in sepsis and increased eosinophil activity in ARDS are needed.  |
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