中性粒细胞与烧伤脓毒症

孙炳伟; 王逸凡; 杨云稀

doi:10.3760/cma.j.cn501225-20240329-00109

中性粒细胞与烧伤脓毒症

doi: 10.3760/cma.j.cn501225-20240329-00109

南京医科大学附属苏州医院烧伤整形科,苏州　　215002

基金项目:

国家自然科学基金联合基金重点项目 U21A20370

国家自然科学基金面上项目 82072217, 81772135

详细信息

通讯作者:
孙炳伟,Email：sunbinwe@hotmail.com

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出版历程
- 收稿日期: 2024-03-29

Neutrophil and burn sepsis

Department of Burn and Plastic Surgery, Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou 215002, China

Funds:

Key Program of Joint Fund of National Natural Science Foundation of China U21A20370

General Program of National Natural Science Foundation of China 82072217, 81772135

More Information

Corresponding author: Sun Bingwei, Email: sunbinwe@hotmail.com

摘要

摘要: 脓毒症是严重烧伤最常见的并发症,也是危害危重烧伤患者生命的首要因素。烧伤脓毒症患者的病死率高达75%。中性粒细胞是先天性免疫细胞之一,也是感染部位募集最早、最多的免疫细胞,在局部感染的清除和损伤组织修复方面发挥关键作用。众多研究已深入揭示了烧伤脓毒症的发病和进展机制,中性粒细胞在其中的作用逐渐明朗。该文详细阐述了中性粒细胞在烧伤脓毒症发生、发展中的关键机制,并基于中性粒细胞在烧伤脓毒症中的独特生物学行为,探讨了其在烧伤脓毒症预警与预后判断方面的价值以及烧伤脓毒症的潜在治疗手段。
- 烧伤 /
- 脓毒症 /
- 中性粒细胞 /
- 机制 /
- 预警
Abstract: Sepsis is the most common complication of severe burns and a primary risk factor for endangering the lives of critically severe burn patients. The mortality rate of burn sepsis patients was up to 75%. Neutrophils are one of the innate immune cells and are the earliest and most recruited immune cells at the site of infection, which play a key role in the removal of local infection and the repair of damaged tissue. Many studies have deeply revealed the pathogenesis and progression mechanism of burn sepsis, in which the role of neutrophils has gradually become clear. This paper elaborated on the key mechanisms of neutrophils in the occurrence and evolution of burn sepsis, explored the value of neutrophils in the early warning and prognosis judgement, and the potential therapeutic methods of burn sepsis based on the unique biological behavior of neutrophils in burn sepsis.
- Burns /
- Sepsis /
- Neutrophil /
- Mechanism /
- Early warning
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参考文献(53)

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Table 1. 中性粒细胞相关烧伤脓毒症预警指标的定义和意义

指标	定义	意义
CD64	一种跨膜糖蛋白,IgG的Fc段受体之一,仅在静息中性粒细胞中低表达	免疫反应的早期阶段CD64即在中性粒细胞膜表面表达,其对脓毒症患者的早期诊断及预后评价具有重要意义^{[24, 25]}。
CD177/CD10	中性粒细胞异质性表达的膜表面蛋白	脓毒症患者的中性粒细胞CD177表达升高,CD10表达降低,2种蛋白的水平呈负相关^[26]。
嗅素蛋白4	一种由外泌体分泌的中性粒细胞特异性颗粒蛋白	在烧伤脓毒症患者中嗅素蛋白4阳性中性粒细胞的比例升高,其比例升高与不良预后相关^{[27, 28]}。
PD-L1	一种在免疫细胞中表达的共抑制分子	脓毒症时,中性粒细胞PD-L1高表达并通过直接接触机制诱导淋巴细胞凋亡。PD-L1的水平与脓毒症的发生、发展密切相关^{[29, 30]}。
肝素结合蛋白	来源于中性粒细胞的颗粒蛋白,由活化的中性粒细胞脱颗粒后释放	脓毒症时,中性粒细胞等大量释放肝素结合蛋白。肝素结合蛋白在早期识别脓毒症方面具有较强的敏感性和特异性^[20,31]。
MDSC	粒细胞样骨髓来源的抑制性细胞	脓毒症状态下,外周循环MDSC水平升高,从而抑制T细胞增殖和活化^[32]。
钙卫蛋白	由2个亚基S100A8和S100A9组成,约占中性粒细胞胞质蛋白的40%	脓毒症时,血清钙卫蛋白浓度明显升高,提示患者预后不良。S100A8在严重烧伤患者的外周血中高表达,提示患者具有更高的死亡风险^{[33, 34, 35]}。
sTREM-1	表达于中性粒细胞等细胞表面的跨膜糖蛋白	在脓毒症患者中,外周循环的sTREM-1水平升高,且sTREM-1水平升高与脓毒症休克患者的病死率升高有关^{[36, 37]}。
TLR4	表达于中性粒细胞等细胞中的一种Ⅰ型跨膜蛋白	脓毒症患者体内TLR4的表达急剧增加,且TLR4可通过相关信号转导通路的激活来推动脓毒症的进展^[38]。
注：CD为分化抗原,PD-L1为程序性死亡受体配体1,MDSC为髓源性抑制细胞,sTREM-1为可溶性髓样细胞触发受体-1,TLR4为Toll样受体4