{"id":15906,"date":"2018-09-03T05:24:28","date_gmt":"2018-09-02T21:24:28","guid":{"rendered":"http:\/\/csccm.org.cn\/?p=15906"},"modified":"2018-09-21T07:24:30","modified_gmt":"2018-09-20T23:24:30","slug":"%e9%99%88%e5%be%b7%e6%98%8c%e6%95%99%e6%8e%88%ef%bc%9a%e5%af%b9%e5%8d%b1%e9%87%8d%e7%97%85%e5%8c%bb%e5%ad%a636%e5%b9%b4%e7%9a%84%e5%8f%8d%e6%80%9d%e4%b8%8e%e5%89%8d%e7%9e%bb","status":"publish","type":"post","link":"https:\/\/csccm.org.cn\/?p=15906","title":{"rendered":"[\u9648\u5fb7\u660c\u6559\u6388]\uff1a\u5bf9\u5371\u91cd\u75c5\u533b\u5b6636\u5e74\u7684\u53cd\u601d\u4e0e\u524d\u77bb"},"content":{"rendered":"

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1970\u5e74\u4ee3\uff0c\u5e94\u7528\u80ba\u52a8\u8109\u6f02\u6d6e\u5bfc\u7ba1\u53ef\u4ee5\u5bf9\u8840\u6d41\u52a8\u529b\u5b66\u7684\u53d8\u5316\u8fdb\u884c\u5e8a\u8fb9\u53ca\u65f6\u7684\u3001\u52a8\u6001\u7684\u76d1\u6d4b\u3002\u8fd9\u9879\u6280\u672f\u5728\u5df4\u9ece\u6559\u5b66\u533b\u9662\u7684ICU\u88ab\u5e7f\u6cdb\u5e94\u7528\u3002\u7b2c\u4e8c\u5b66\u5e74\uff0c\u6211\u53d6\u5f97\u4e86\u6cd5\u56fd\u4e34\u5e8a\u533b\u5e08\u7684\u8d44\u683c\uff0c\u53c2\u52a0\u4e86\u75c5\u623f\u4e34\u5e8a\u7684\u5b9e\u8df5\u3002\u6211\u6ce8\u610f\u5230\uff0c\u8fd9\u9879\u521b\u65b0\u6280\u672f\u53ef\u4ee5\u5bf9\u5371\u91cd\u75c5\u4eba\u75c5\u60c5\u7684\u53d8\u5316\u53d6\u5f97\u53ca\u65f6\u7684\u3001\u52a8\u6001\u7684\u4fe1\u606f\u3002\u5bf9\u76d1\u6d4b\u4eea\u6240\u663e\u793a\u7684\u8840\u6d41\u52a8\u529b\u5b66\u6539\u53d8\u7684\u6570\u636e\u8fdb\u884c\u5206\u6790\uff0c\u53ef\u4ee5\u5e2e\u52a9\u4e34\u5e8a\u533b\u5e08\u5bf9\u53d8\u5316\u7740\u7684\u75c5\u60c5\u4f5c\u51fa\u53ca\u65f6\u7684\u5224\u65ad\uff0c\u5bf9\u6cbb\u7597\u4f5c\u51fa\u76f8\u5e94\u7684\u8c03\u6574\uff0c\u5e76\u68c0\u9a8c\u6cbb\u7597\u7684\u6548\u5e94\u3002\u5bf9\u6211\u6765\u8bf4\uff0c\u8fd9\u662f\u4e00\u79cd\u65b0\u7684\u5b9e\u8df5\uff0c\u5f15\u8d77\u6211\u5bf9\u5371\u91cd\u75c5\u4eba\u673a\u4f53\u53cd\u5e94\u7684\u91cd\u89c6\u3002\u8fd9\u662f\u6211\u7559\u6cd5\u5b66\u4e60\u7684\u4e00\u6b21\u611f\u609f\u3002<\/p>\n

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1973\u5e74\uff0c<\/strong>Tilney\u53d1\u73b0\u5728\u4e3b\u52a8\u8109\u7624\u5207\u9664\u624b\u672f\u540e\u53ef\u4ee5\u53d1\u751f\u591a\u4e2a\u8fdc\u8ddd\u79bb\u7684\u5668\u5b98\u529f\u80fd\u8870\u7aed\u3002Eiseman\u7b49\u5047\u8bbe\uff0c\u5728\u67d0\u79cd\u6025\u6027\u75c5\uff0c\u6bd4\u5982\u4e25\u91cd\u611f\u67d3\u6216\u4e25\u91cd\u521b\u4f24\u7b49\u60c5\u51b5\u4e0b\uff0c\u6709\u4e00\u79cd\u201c\u89e6\u53d1\u673a\u5236\u201d\uff0c\u542f\u52a8\u4e0d\u6070\u5f53\u7684\u673a\u4f53\u53cd\u5e94\uff0c\u5e8f\u8d2f\u6027\u5730\u5f15\u53d1\u8fdc\u8ddd\u79bb\u7684\u3001\u539f\u6765\u5065\u5eb7\u7684\u5668\u5b98\u50cf\u591a\u7c73\u8bfa\u9aa8\u90a3\u6837\u4e00\u4e2a\u4e00\u4e2a\u5730\u5012\u4e0b\u3002Eiseman\u7b49\u79f0\u4e4b\u4e3a\u201c\u5e8f\u8d2f\u6027\u591a\u5668\u5b98\u529f\u80fd\u8870\u7aed\u7efc\u5408\u75c7\u201d\u3002\u4f46\u662f\uff0c\u4ed6\u4eec\u4e0d\u77e5\u9053\u201c\u6fc0\u53d1\u673a\u5236\u201d\u662f\u4ec0\u4e48\u3002<\/p>\n

1985\u5e74\uff0cAggarwall\u7b49\u7b2c\u4e00\u6b21\u5206\u79bb\u51fa\u708e\u75c7\u7ec6\u80de\u56e0\u5b50\u3002\u540e\u7ee7\u7684\u7814\u7a76\u53d1\u73b0\u66f4\u591a\u7684\u4fc3\u708e\u75c7\u7ec6\u80de\u56e0\u5b50\u548c\u6297\u708e\u75c7\u7ec6\u80de\u56e0\u5b50\u3002Roger Bone\u5047\u8bbe\u201c\u708e\u75c7\u7ec6\u80de\u56e0\u5b50\u4e0e\u6297\u708e\u75c7\u7ec6\u80de\u56e0\u5b50\u4e4b\u95f4\u7684\u5e73\u8861\u7d0a\u4e71\u201d\u53ef\u80fd\u662f\u4e25\u91cd\u611f\u67d3\u548c\u591a\u5668\u7ba1\u529f\u80fd\u8870\u7aed\u7684\u201c\u6fc0\u53d1\u673a\u5236\u201d\u30021990\u5e74\u4ee3\u521d\uff0c\u6b27\u7f8e\u5b66\u8005\u7ec4\u7ec728 \u9879\u8de8\u56fd\u3001\u591a\u4e2d\u5fc3\u3001\u524d\u77bb\u5bf9\u7167\u6027\u4e34\u5e8a\u8bd5\u9a8c\uff0c\u5e94\u7528\u708e\u75c7\u7ec6\u80de\u56e0\u5b50\u9889\u6297\u5242\u7b49\uff0c\u60f3\u4ee5\u6b64\u963b\u65ad\u4e25\u91cd\u611f\u67d3\u7684\u5168\u8eab\u708e\u75c7\u53cd\u5e94\u3002\u7ed3\u679c\u65e0\u4e00\u4f8b\u6210\u529f\u3002\u708e\u75c7\u53cd\u5e94\u4e0d\u8db3\u4ee5\u89e3\u91ca\u4e25\u91cd\u611f\u67d3\u548c\u591a\u5668\u5b98\u529f\u80fd\u8870\u7aed\u7684\u201c\u6fc0\u53d1\u673a\u5236\u201d\u3002Bone\u7684\u7406\u8bba\u5047\u8bbe\u4e5f\u4e0d\u80fd\u6307\u5bfc\u4e34\u5e8a\u5b9e\u8df5\u3002<\/p>\n

\u90a3\u4e48\uff0c\u95ee\u9898\u51fa\u5728\u54ea\u91cc\u5462\uff1f\u66fe\u6559\u6388\u91cd\u89c6\u4e34\u5e8a\u5de5\u4f5c\u3002ICU\u7ec4\u5efa\u521d\u671f\uff0c\u867d\u7136\u62b1\u75c5\u5728\u8eab\uff0c\u4ed6\u575a\u6301\u53c2\u52a0ICU\u75c5\u623f\u5de1\u8bca\u3002\u5728ICU\u4e34\u5e8a\u5b9e\u8df5\u4e2d\uff0c\u4ed6\u6df1\u5207\u611f\u53d7\u5230\u6211\u4eec\u9762\u4e34\u7684\u95ee\u9898\u3002\u4ed6\u63d0\u51fa\uff1a\u201c\u611f\u67d3\u75c5\u4eba\u4e3a\u4ec0\u4e48\u6b7b\u4ea1\uff1f\u201d\u9057\u61be\u7684\u662f\u66fe\u5baa\u4e5d\u6559\u6388\u57281985 \u5e74\u53bb\u4e16\u3002\u4ed6\u6ca1\u6709\u65f6\u95f4\u7ee7\u7eed\u5371\u91cd\u75c5\u4eba\u52a0\u5f3a\u533b\u7597\u7684\u5b9e\u8df5\uff0c\u6ca1\u6709\u65f6\u95f4\u5bf9\u5371\u91cd\u75c5\u533b\u5b66\u7684\u7406\u8bba\u8fdb\u4e00\u6b65\u63a2\u7d22\u3002\u66fe\u6559\u6388\u672a\u7adf\u7684\u4e8b\u4e1a\u5e94\u8be5\u7531\u4ed6\u7684\u5b66\u751f\u4eec\u7ee7\u627f\u4e0b\u53bb\u3002\u66fe\u6559\u6388\u63d0\u51fa\u7684\u95ee\u9898\uff1a\u201c\u611f\u67d3\u75c5\u4eba\u4e3a\u4ec0\u4e48\u6b7b\u4ea1\uff1f\u201d\uff0c\u5c06\u662f\u6211\u4eec\u4eca\u540e\u63a2\u7d22\u548c\u7814\u7a76\u7684\u76ee\u6807\u3002<\/p>\n

1992\u5e74\u81f32002\u5e74\u671f\u95f4\uff0c\u6211\u628a\u4e25\u91cd\u611f\u67d3\u4e34\u5e8a\u57fa\u7840\u7814\u7a76\u653e\u5230\u91cd\u70b9\u4f4d\u7f6e\u4e0a\u3002\u6211\u548c\u51e0\u4f4d\u535a\u58eb\u7814\u7a76\u751f\u5408\u4f5c\u30021992\u5e74\u7acb\u9898\u7814\u7a76\uff0c\u4f53\u5916\u89c2\u5bdf\u5728\u80ba\u6ce1\u541e\u566c\u7ec6\u80de\u7684\u708e\u75c7\u53cd\u5e94\u4e2d\uff0c\u708e\u75c7\u7ec6\u80de\u56e0\u5b50\u4e0e\u5185\u6e90\u6027\u6297\u708e\u75c7\u7ec6\u80de\u56e0\u5b50\u5171\u540c\u53c2\u4e0e\u548c\u76f8\u4e92\u4f5c\u7528\u3002\u53e6\u4e00\u65b9\u9762\uff0c\u83b7\u6089\u5df1\u6709\u7684\u7814\u7a76\u8bc1\u660e\uff0c\u80de\u8d28\u5185\u8f6c\u5f55\u56e0\u5b50\u5c06\u8fdb\u5165\u7ec6\u80de\u6838\u800c\u88ab\u6d3b\u5316\uff0c\u5bfc\u81f4\u5927\u91cf\u4fc3\u708e\u75c7\u56e0\u5b50\u751f\u6210\u30021997\u5e74\u7acb\u9898\u7814\u7a76\uff0c\u7ed3\u679c\u663e\u793a\u5728\u8102\u591a\u7cd6\uff08LPS\uff09\u653b\u51fb\u524d\uff0c\u5bf9\u4f53\u5916\u57f9\u517b\u7684\u5e93\u666e\u5f17\u7ec6\u80de\u7ed9\u4e88\u836f\u7269\u5904\u7406\uff0c\u53ef\u4ee5\u904f\u5236\u6838\u8f6c\u5f55\u56e0\u5b50-\u03baB\uff08NF-\u03baB\uff09\u7684\u6d3b\u5316\uff0c\u6291\u5236TNF-\u03b1\u3001IL-6\u548cIL-10\u7b49\u7684mRNA\u8868\u8fbe\u53ca\u5206\u6ccc\uff0c\u964d\u4f4e\u5b9e\u9a8c\u52a8\u7269\u7684\u6b7b\u4ea1\u7387\u30021998\u5e74\u7acb\u9898\uff0c\u5c31\u708e\u75c7\u56e0\u5b50\u4e0d\u540c\u7b49\u4f4d\u57fa\u56e0\u5bf9\u5168\u8eab\u611f\u67d3\u9884\u540e\u53ef\u80fd\u4ea7\u751f\u7684\u5f71\u54cd\u8fdb\u884c\u7814\u7a76\u3002\u7ed3\u679c\u5ba3\u793a\uff0c\u4fc3\u708e\u75c7\u7ec6\u80de\u56e0\u5b50\u57fa\u56e0IL-1A\u6216IL-1B\u7b49\u4f4d\u57fa\u56e02\u4e0e\u6297\u708e\u75c7\u7ec6\u80de\u56e0\u5b50IL-1RN\u7b49\u4f4d\u57fa\u56e02\u540c\u65f6\u51fa\u73b0\u65f6\uff0c\u75c5\u4eba\u7684\u75c5\u6b7b\u7387\u6781\u9ad8\uff0880%\uff09\u3002\u4f46\u51fa\u73b0\u7b49\u4f4d\u57fa\u56e01\/1\u57fa\u56e0\u578b\u7eaf\u5408\u5b50\uff0c\u75c5\u4eba\u75c5\u6b7b\u7387\u4e3a0\u3002\u7814\u7a76\u8bba\u6587\u53d1\u8868\u57282002\u5e74\u7f8e\u56fdCritical Care Medicine \u6742\u5fd7\u3002\u56de\u8fc7\u5934\u6765\u770b\uff0c\u6211\u628a\u4e25\u91cd\u611f\u67d3\u7684\u4e34\u5e8a\u57fa\u7840\u7814\u7a76\uff0c\u7b2c\u4e00\u9636\u6bb5\u7126\u70b9\u96c6\u4e2d\u5728\u673a\u4f53\u7684\u708e\u75c7\u53cd\u5e94\uff0c\u7b2c\u4e8c\u9636\u6bb5\u7126\u70b9\u8f6c\u5411\u673a\u4f53\u514d\u75ab\u53cd\u5e94\u3002<\/p>\n

\u5b9e\u9645\u4e0a\uff0c\u708e\u75c7\u53cd\u5e94\u548c\u514d\u75ab\u53cd\u5e94\u90fd\u662f\u673a\u4f53\u62b5\u5fa1\u75c5\u539f\u7684\u91cd\u8981\u673a\u5236\u548c\u624b\u6bb5\u3002\u4f46\u662f\uff0c\u5728\u4f20\u7edf\u4e0a\uff0c\u4eba\u4e3a\u5730\u5f62\u6210\u4e86\u4e24\u4e2a\u4e0d\u540c\u7684\u7814\u7a76\u9886\u57df\u3002\u75c5\u7406\u5b66\u5bb6\u5173\u6ce8\u708e\u75c7\u53cd\u5e94\uff0c\u7279\u522b\u662f\u708e\u75c7\u7ec6\u80de\u6d3b\u5316\u548c\u7ec4\u7ec7\u635f\u4f24\u3002\u514d\u75ab\u5b66\u5bb6\u5173\u6ce8\u6dcb\u5df4\u7ec6\u80de\u4ecb\u5bfc\u7684\u9002\u5e94\u6027\u514d\u75ab\u53cd\u5e94\u5728\u4e25\u91cd\u611f\u67d3\u4e2d\u7684\u4f5c\u7528\u3002\u4e24\u4e2a\u9886\u57df\u95f4\u7684\u4ea4\u4e49\u975e\u5e38\u6709\u9650\u3002<\/p>\n

\u8fd9\u79cd\u72b6\u51b5\u7ec8\u4e8e\u5f97\u5230\u4e86\u6539\u53d8\u30021989\u5e74\uff0cCharles Janeway\u6559\u6388\uff0c\u63d0\u51fa\u5929\u7136\u514d\u75ab\u53ef\u4ee5\u8bc6\u522b\u75c5\u539f\u4f53\uff0c\u6240\u4ee5\u662f\u5bf9\u6297\u611f\u67d3\u7684\u7b2c\u4e00\u7ebf\u3002\u4ed6\u4e5f\u63d0\u51fa\u5929\u7136\u514d\u75ab\u5bf9\u9002\u5e94\u6027\u514d\u75ab\u7684\u8c03\u63a7\u7684\u539f\u5219\u3002\u4ed6\u7684\u8bbe\u60f3\u6784\u6210\u73b0\u4ee3\u514d\u75ab\u5b66\u5bf9\u5929\u7136\u514d\u75ab\u7684\u4f5c\u7528\u4ee5\u53ca\u5929\u7136\u514d\u75ab\u4e0e\u9002\u5e94\u6027\u514d\u75ab\u4e4b\u95f4\u7684\u5185\u5728\u8054\u7cfb\u7b49\u95ee\u9898\u7684\u7406\u89e3\u3002<\/p>\n

Bruce Beutler\u7387\u5148\u53d1\u73b0Toll\u6837\u53d7\u4f53\u7684\u5bb6\u65cf\u6210\u5458\u4e4b\u4e00\uff0cTLR4\u53ef\u4ee5\u8bc6\u522b\u7ec6\u83cc\u8102\u591a\u7cd6\u3002\u6b64\u540e\uff0c\u5176\u4ed6\u5bb6\u65cf\u6210\u5458\u4e5f\u88ab\u7edc\u7eed\u53d1\u73b0\u3002\u8fd9\u4e9b\u53d7\u4f53\u88ab\u7edf\u79f0\u4e3a\u75c5\u539f\u5206\u5b50\u6a21\u5f0f\u53d7\u4f53\uff0c\u6216\u5929\u7136\u514d\u75ab\u53d7\u4f53\u3002\u8fd9\u4e9b\u53d7\u4f53\u5728\u5371\u91cd\u75be\u75c5\u7684\u53d1\u75c5\u673a\u5236\uff0c\u5305\u62ec\u611f\u67d3\u53d1\u5c55\u8fc7\u7a0b\u4e2d\u51fa\u73b0\u5168\u8eab\u6027\u708e\u75c7\u548c\u4f11\u514b\u7b49\u95ee\u9898\uff0c\u6709\u91cd\u8981\u7684\u610f\u4e49\u3002\u53e6\u4e00\u65b9\u9762\uff0cRalph Steinman\u6559\u6388\u53d1\u73b0\u4e00\u79cd\u7279\u6b8a\u7684\u5929\u7136\u514d\u75ab\u7ec6\u80de\uff0c\u5373\u6811\u7a81\u72b6\u7ec6\u80de\u3002\u8fd9\u4e9b\u7ec6\u80de\u867d\u7136\u5c5e\u4e8e\u5929\u7136\u514d\u75ab\u7cfb\u7edf\uff0c\u5374\u5bf9\u6dcb\u5df4\u7ec6\u80de\u7684\u6d3b\u5316\u53d1\u6325\u5173\u952e\u7684\u4f5c\u7528\uff0c\u4e5f\u5c31\u662f\u8bf4\u5728\u5929\u7136\u514d\u75ab\u4e0e\u9002\u5e94\u6027\u514d\u75ab\u4e24\u8005\u4e4b\u95f4\u6709\u7740\u8854\u63a5\u3002\u8fd9\u79cd\u8ba4\u8bc6\u5728\u8fc7\u53bb\u4e00\u76f4\u88ab\u5ffd\u7565\u3002\u4ed6\u4eec\u4e24\u4f4d\u90fd\u662f2011\u5e74\u8bfa\u8d1d\u5c14\u5956\u5f97\u4e3b\u3002\u8fd9\u4e24\u4e2a\u65b9\u9762\u7684\u91cd\u5927\u53d1\u73b0\u63a8\u52a8\u4e86\u514d\u75ab\u7cfb\u7edf\u7684\u7814\u7a76\uff0c\u660e\u786e\u63d0\u51fa\u5929\u7136\u514d\u75ab\u7cfb\u7edf\u4e0e\u9002\u5e94\u6027\u514d\u75ab\u7cfb\u7edf\u6709\u7740\u4e0d\u53ef\u5206\u5272\u7684\u8054\u7cfb\u3002<\/p>\n

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