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Cyclooxygenase Inhibition in Sepsis: Is There Life after Death?

机译：败血症中的环氧氧酶抑制：死后有生命吗？

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摘要

Prostaglandins are important mediators and modulators of the inflammatory response to infection. The prostaglandins participate in the pathogenesis of hemodynamic collapse, organ failure, and overwhelming inflammation that characterize severe sepsis and shock. In light of this, cyclooxygenase (COX) inhibiting pharmacological agents have been extensively studied for their capacity to ameliorate the aberrant physiological and immune responses during severe sepsis. Animal models of sepsis, using the systemic administration of pathogen-associated molecular patterns (PAMPs) or live pathogens, have been used to examine the effectiveness of COX inhibition as a treatment for severe sepsis. These studies have largely shown beneficial effects on mortality. However, human studies have failed to show clinical utility of COX inhibitor treatment in severely septic patients. Why this approach "worked" in animals but not in humans might reflect differences in the controlled nature of animal investigations compared to human studies. This paper contrasts the impact of COX inhibitors on mortality in animal models of sepsis and human studies of sepsis and examines potential reasons for differences between these two settings. Sepsis is a major cause of morbidity and mortality worldwide , with more than 750,000 cases per year in the United States alone. Despite improvements in diagnosis and therapeutics, there is an ongoing need for better treatments. Sepsis can be defined as a "systemic illness caused by microbial invasion of normally sterile parts of the body" , and it can be complicated by organ dysfunction (severe sepsis) or hypotension refractory to volume resuscitation (septic shock) .
机译：前列腺素是对感染的炎症反应的重要介质和调节剂。前列腺素参与血流动力学崩溃，器官衰竭和压倒性炎症的发病机制，表征严重的败血症和休克。鉴于这种情况，抑制药理学药物的环加氧基酶（COX）已经过度研究了它们在严重败血症期间改善异常生理和免疫应答的能力。败血症的动物模型，使用过源性分子模式（PAMP）或活病原体的系统施用，用于检查COX抑制作为严重败血症治疗的有效性。这些研究在很大程度上表现出对死亡率有益的影响。然而，人类研究未能在严重的脓毒症患者中显示COX抑制剂治疗的临床效用。为什么这种方法在动物中“工作”，但不在人类中可能反映与人类研究相比动物调查的对照性质的差异。本文对比脓毒症动物模型中COX抑制剂对败血症和人类研究中死亡率的影响，并检查了这两种环境之间差异的潜在原因。败血症是全世界发病率和死亡率的主要原因，仅在美国每年超过75万件案例。尽管诊断和治疗方法有所改善，但持续需要更好的治疗方法。败血症可以定义为“由身体通常无菌部分的微生物侵袭导致的全身疾病”，它可以通过器官功能障碍（严重脓血）或低血压耐火到体积复苏（化粪池）复杂化。

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  • 来源
    《Mediators of inflammation》 |2012年第2期|共7页
  • 作者

    David M. Aronoff;

  • 作者单位

    Division of Infectious Diseases Department of Internal Medicine and Department of Microbiology and;

  • 收录信息
  • 原文格式 PDF
  • 正文语种 eng
  • 中图分类 病理学;
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