 嗜酸性粒細(xì)胞在膿毒癥和急性呼吸窘迫綜合征中的作用：應(yīng)用范圍研究 貴州醫(yī)科大學(xué) 高鴻教授課題組 翻譯：任文鑫 編輯：佟睿 審校：曹瑩 感染性休克和急性呼吸窘迫綜合征（ARDS）的特點(diǎn)是機(jī)體免疫反應(yīng)失調(diào),，可能對激素治療有反應(yīng)。嗜酸性粒細(xì)胞導(dǎo)致2型炎癥,，通常對類固醇治療有反應(yīng),；它們在膿毒癥和ARDS的免疫失調(diào)和轉(zhuǎn)歸中的作用尚不清楚。 從開始到2020年9月9日,，對Cochrane圖書館,、MEDLINE和EMBASE進(jìn)行了系統(tǒng)的搜索。搜索關(guān)鍵詞是：嗜酸性粒細(xì)胞,、敗血癥,、敗血癥性休克和ARDS。兩位評審員獨(dú)立篩選了摘要和文本,，并提取了有關(guān)疾病嚴(yán)重程度和臨床結(jié)果的數(shù)據(jù),。 確定了39項(xiàng)研究：30項(xiàng)評估膿毒癥患者的血清嗜酸性粒細(xì)胞計(jì)數(shù)，1項(xiàng)評估膿毒癥患者的嗜酸性粒細(xì)胞活性,，3項(xiàng)評估ARDS患者的支氣管肺泡灌洗（BAL）嗜酸性粒細(xì)胞計(jì)數(shù),，4項(xiàng)評估ARDS患者的嗜酸性粒細(xì)胞活性，1項(xiàng)評估ARDS患者的外周嗜酸性粒細(xì)胞計(jì)數(shù),。11項(xiàng)研究顯示嗜酸性粒細(xì)胞減少與膿毒癥之間存在關(guān)聯(lián),，8項(xiàng)研究發(fā)現(xiàn)在重癥監(jiān)護(hù)病房入院48小時(shí)后持續(xù)嗜酸性粒細(xì)胞減少可預(yù)測膿毒癥患者的死亡率和再入院率。三項(xiàng)研究發(fā)現(xiàn)ARDS患者BAL嗜酸性粒細(xì)胞計(jì)數(shù)較低,，但有一項(xiàng)研究發(fā)現(xiàn)ARDS晚期BAL嗜酸性粒細(xì)胞水平升高,。三項(xiàng)研究發(fā)現(xiàn)，ARDS患者BAL中的嗜酸性粒細(xì)胞活性標(biāo)志物較高,，并與ARDS的嚴(yán)重程度相關(guān),。 持續(xù)性外周嗜酸性粒細(xì)胞減少是細(xì)菌性敗血癥的標(biāo)志,，與不良預(yù)后獨(dú)立相關(guān)。支氣管肺泡灌洗液中嗜酸性粒細(xì)胞計(jì)數(shù)在ARDS早期較低,，但在ARDS晚期增加,，而嗜酸性粒細(xì)胞活性標(biāo)志物升高與ARDS嚴(yán)重程度相關(guān)。需要進(jìn)一步研究膿毒癥導(dǎo)致嗜酸性粒細(xì)胞減少和ARDS中嗜酸性粒細(xì)胞活性增加的機(jī)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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