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脓毒症是目前临床急危重症医学面临的重要问题,是住院病人死亡的重要原因之一。2016年,脓毒症和感染性休克的第三版国际共识提出脓毒症3.0的新定义为机体对感染的反应失调进而导致多器官功能障碍[1]。脓毒症如不能及早被发现并及时处理,可导致脓毒症休克、多脏器衰竭和死亡。最新报道显示,2017年全球脓毒症病人人数达4 890万,其中1 100万例病人死亡,占全球死亡人数的20%[2]。在美国,每年有170万住院病人出现脓毒症,并导致27万人死亡[3]。预防其诱因,减轻其并发症或器官功能障碍成为全球亟待解决的问题之一。
心脏功能障碍是脓毒症所导致的最常见的器官功能障碍,也称为脓毒性心肌病(sepsis-induced cardiomyopathy,SIC),SIC病人心脏出现结构和功能上的改变,最早的临床表现为左、右心室收缩和舒张功能障碍,心功能不全,主要有3个特征:左心室扩张、射血分数下降以及7~10 d内射血分数恢复[4]。
线粒体不仅是负责营养代谢和能量产生的高度动态的细胞器,而且线粒体融合分裂、生物合成、介导不同细胞死亡等过程还共同参与疾病的发生发展,线粒体稳态对维护机体重要脏器的生理功能发挥关键作用。脓毒症诱导的心肌线粒体损伤或功能障碍是心肌细胞代谢障碍、能量产生不足、氧化应激、免疫失调的重要原因,严重时导致心脏等多器官衰竭,甚至死亡。因此,减轻线粒体功能障碍对于维持心肌正常功能活动至关重要,并且可能是为SIC提供更好预后的一种重要的可行措施[5]。
SIC时,线粒体功能障碍主要表现为线粒体抗氧化系统功能失衡、钙超载、线粒体生物发生、促进一氧化氮生成、线粒体解偶联、线粒体能量代谢紊乱、参与不同类别细胞死亡方式等机制。
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