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脓毒症是机体对感染的免疫反应失调而引发危及生命的多器官功能障碍[1],是感染致死的首要原因。据统计,全球每年有4 700万~5 000万脓毒症病例,脓毒症相关死亡人数至少为1 100万[2],约占全年总死亡人数的1/5。脓毒症的病理生理学过程包含宿主全身过度炎症反应和免疫抑制的复杂相互作用,其中,免疫抑制会导致院内感染和体内病毒重激活,甚至出院后长期持久的免疫失能状态,脓毒症患者在免疫麻痹期的累积病死率约为总病死率的90%[3]。脓毒症免疫麻痹主要表现为细胞因子分泌失调、抗原提呈细胞功能减弱、T细胞亚群稳态失衡[4],最终造成机会性感染的易感性增加。然而,临床上对于脓毒症的治疗手段十分有限,阻断TNF-α[5-6]、TLR4[7-8]等控制炎症级联反应的免疫抑制疗法在临床试验中也相继失败;幸运的是,纠正脓毒症免疫麻痹的免疫激活疗法异军突起,为脓毒症治疗带来了曙光,且许多疗法已被临床试验证实有效。本文对基于免疫麻痹纠正的脓毒症免疫疗法研究进展进行综述。
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