黄坡,郭玉红,徐霄龙,何莎莎,刘清泉

• 1:首都医科大学
• 2:首都医科大学附属北京中医医院
• 3:北京市中医研究所
• 4:中医感染性疾病基础研究北京市重点实验室

摘要(Abstract)：

重症肺炎具有高发病率、高病死率的特点。近年来重症肺炎的免疫方面研究成为热点,并有望成为重症肺炎治疗新的突破口。Treg/Th17的失衡在重症肺炎的发病中起到关键作用,m TOR主要通过PI3K/Akt/mTOR信号通路调控Treg/Th17的平衡。中医药在重症肺炎的耐药和免疫调节方面具有一定的优势,取得了一定的研究进展。

关键词(KeyWords)： 重症肺炎;信号通路;免疫;mTOR;Treg/Th17;中医药

Abstract:

Keywords:

基金项目(Foundation): 国家自然科学基金项目(81673934);; 北京市医院管理局重点医学专业发展计划(ZYLX201611)

作者(Author): 黄坡,郭玉红,徐霄龙,何莎莎,刘清泉

参考文献(References)：

• [1] Mathur S,Fuchs A,Bielicki J,et al. Antibiotic use for community-acquired pneumonia in neonates and children:WHO evidence review[J]. Paediatr Int Child Health,2018,38(sup1):S66-S75.
• [2] Muscedere JG,Day A,Heyland DK. Mortality, attributable mortality,and clinical events as end points for clinical trials of ventilator-associated pneumonia and hospital-acquired pneumonia[J]. Clin Infect Dis,2010,51(Suppl 1):S120-125.
• [3] Ning P,Zheng Y,Luo Q,et al. Metabolic profiles in community-acquired pneumonia:developing assessment tools for disease severity[J]. Crit Care,2018,22(1):130.
• [4] Welte T,Dellinger RP,Ebelt H,et al. Efficacy and safety of trimodulin, a novel polyclonal antibody preparation,in patients with severe community-acquired pneumonia:a randomized,placebo-controlled,double-blind,multicenter,phaseⅡtrial(CIGMA study)[J]. Intensive Care Med,2018,44(4):438-448.
• [5] Pham J,Asif T,Hamarshi MS. Community-acquired pneumonia with methicillin-resistant staphylococcus aureus in a patient admitted to the intensive care unit:a therapeutic challenge[J]. Cureus,2018,10(1):e2019.
• [6]中国医师协会急诊医师分会.中国急诊重症肺炎临床实践专家共识[J].中国急救医学,2016,36(2):97-107.
• [7] Mandell LA,Wunderink RG,Anzueto A,et al. Infectious diseases society of America/American thoracic society consensus guidelines on the management of community-acquired pneumonia in adults[J]. Clin Infect Dis,2007,44(Suppl 2):S27-72.
• [8]蔡新新. Th17/Treg细胞在重症肺炎的研究及意义[D].桂林:桂林医学院,2015.
• [9]王凯,高伟. PI3K/Akt/mTOR通路在调控器官移植Treg/Th17平衡中的作用[J].实用器官移植电子杂志,2018,6(1):72-75.
• [10]周丽,徐洪山,赵丹,等.免疫治疗对重症肺炎患者免疫功能指标及炎症因子的影响[J].检验医学与临床,2017,14(18):2658-2661.
• [11]卢胜家,邵婷婷.细胞免疫功能与老年细菌性肺炎及其严重程度的相关性[J].中国老年学杂志,2017,37(18):4590-4592.
• [12]游正铭.淋巴细胞亚群检测在重症肺炎治疗及预后评估中的意义[J].中国卫生检验杂志,2017,27(12):1768-1769,1772.
• [13]卢幼然,丁军颖,刘清泉.重症肺炎免疫失衡机制及中医药治疗研究进展[J].解放军医药杂志,2017,29(4):45-49.
• [14]吕丽燕.免疫治疗对重症肺炎患者免疫功能指标及TNF-α、IL-6水平的影响研究[J].中国医学创新,2017,14(12):16-19.
• [15] Schmidt ME,Varga SM. The CD8 T cell response to respiratory virus infections[J]. Front Immunol,2018,9:678.
• [16] Yang C,Chen X,Wei Z,et al. Targeting the class IA PI3K isoforms p110α/δattenuates heart allograft rejection in mice by suppressing the CD4+T lymphocyte response[J]. Am J Transl Res,2018,10(5):1387-1399.
• [17] Nepstad I1,Hatfield KJ1,2,Aaseb覬E,et al. Two acute myeloid leukemia patient subsets are identified based on the constitutive PI3K-Akt-mTOR signaling of their leukemic cells; a functional, proteomic and transcriptomic comparison[J]. Expert Opin Ther Targets,2018,11.
• [18] Sun IH,Oh MH,Zhao L,et al. mTOR complex 1 signaling regulates the generation and function of central and effector Foxp3+regulatory T cells[J]. J Immunol,2018,pii:ji1701477.
• [19] Kolev M,Dimeloe S,Le Friec G,et al. Complement regulates nutrient influx and metabolic reprogramming during Th1 cell responses[J]. Immunity,2015,42(6):1033-1047.
• [20]樊新昱.重症肺炎中医证素分布规律及与预后影响因素相关性研究[D].北京:中国中医科学院,2014.
• [21]于志丹.重症肺炎中医证候与死亡相关危险因素的研究[D].北京:中国中医科学院,2013.
• [22]陈佳杰,李辉. ICU重症肺炎患者病原体与中医证候的回顾性分析[J].中医临床研究,2017,9(12):63-65.
• [23]高洁,刘清泉,马群,等.从伏邪理论看耐药菌感染[J].中医杂志,2011,52(6):536-538.
• [24]孔令博,马群,高洁,等. Effect of qiguiyin decoction(芪归银方)on multidrug-resistant pseudomonas aeruginosa infection in rats[J]. Chinese Journal of Integrative Medicine,2015,21(12):916-921.
• [25]孔令博,郭玉红,付跃峰,等.芪归银方对多重耐药铜绿假单胞菌感染大鼠血清IL-1β水平的影响[J].世界中医药,2016,11(10):1966-1969.
• [26]孔令博,刘清泉,杨琦,等.芪归银方对抗生素体外抑制多重耐药铜绿假单胞菌作用的影响[J].世界中医药,2014,9(3):288-290,295.
• [27]陈爽,林彤彦,穆晓静,等.多重耐药革兰阴性杆菌重症肺炎临床分析[J].中国初级卫生保健,2018,32(3):103-105.
• [28] Li H,Chen X,Zhou SJ,et al. Dauricine combined with clindamycin inhibits severe pneumonia co-infected by influenza virus H5N1 and Streptococcus pneumoniae in vitro and in vivo through NF-κB signaling pathway[J]. J Pharmacol Sci,2018.
• [29] Felix KM,Jaimez IA,Nguyen TV,et al. Gut microbiota contributes to resistance against pneumococcal pneumonia in immunodeficient Rag-/-Mice[J]. Front Cell Infect Microbiol,2018,8:118.