龙展智,童世君

脓毒症是一种由感染引起的全身性炎症反应综合征，病情严重且预后较差。血小板减少在脓毒症患者中很常见，其减少幅度越大，患者病死率越高。因此，明确脓毒症相关性血小板减少的发病机制，以及选择适当的方法及时纠正血小板减少，对改善患者的预后具有非常重要的意义。

脓毒症；血小板减少；发病机制；治疗

[1] Cecconi,M.,et al.,Sepsis and septic shock.Lancet 2018,392(10141),75-87. [2] Ghimire,S.,et al.,Current understanding and future implications of sepsis-induced thrombocytopenia.Eur J Haematol2021,106(3),301-305. [3] Giustozzi,M.,et al.,Coagulopathy and sepsis:Pathophysiology,clinical manifestations and treatment.Blood Rev 2021,50,100864. [4] Venkata,C.,et al.,Thrombocytopenia in adult patients with sepsis:incidence,risk factors,and its association with clinical outcome.J Intensive Care 2013,1(1),9. [5] Zhou,Z.,et al.,The effect of recombinant human thrombopoietin(rhTPO)on sepsis patients with acute severe thrombocytopenia:a study protocol for a multicentre randomised controlled trial(RESCUE trial).BMC Infect Dis 2019,19(1),780. [6] Gonzalez,D.A.,et al.,Sepsis and Thrombocytopenia:A Nowadays Problem.Cureus 2022,14(5),e25421. [7] Wang,H.,et al.,Recombinant Human Thrombopoietin Promotes Platelet Engraftment and Improves Prognosis of Patients with Myelodysplastic Syndromes and Aplastic Anemia after Allogeneic Hematopoietic Stem Cell Transplantation.Biol Blood Marrow Transplant 2017,23(10),1678-1684. [8] Khan,M.A.N.,et al.,Vitamin B12 Deficiency,a Rare Cause of Isolated Thrombocytopenia in Adults.Cureus 2023,15(8),e44162. [9] Pasquariello,S.,et al.,Drug-induced thrombocytopenia in a patient with colorectal cancer:A case report.Oncol Lett 2023,26(3),398. [10] Adelborg,K.,et al.,Disseminated intravascular coagulation:epidemiology,biomarkers,and management.Br J Haematol 2021,192(5),803-818. [11] Benlamkaddem,S.,et al.,The Challenging Aspect of Macrophage Activation Syndrome in the Setting of Sepsis or Systemic Inflammatory Response Syndrome(SIRS).Cureus 2023,15(3),e36228. [12] Kudaravalli,P.,et al.,Acute on Chronic Immune Thrombocytopenia as a Cause of Thrombocytopenia in Sepsis.Cureus 2020,12(5),e8168. [13] Liu,Y.S.,et al.,Isaridin E Protects against Sepsis by Inhibiting Von Willebrand Factor-Induced Endothelial Hyperpermeability and Platelet-Endothelium Interaction.Mar Drugs 2024,22(6). [14] Kapur,R.;Audia,S.,Secondary spleen in immune thrombocytopenia:Not so accessory after all.Br J Haematol 2023,202(1),9-10. [15] Wu,J.,et al.,The interaction between STING and NCOA4 exacerbates lethal sepsis by orchestrating ferroptosis and inflammatory responses in macrophages.Cell Death Dis 2022,13(7),653. [16] Jia,Y.,et al.,Interaction between the SFTSV envelope glycoprotein Gn and STING inhibits the formation of the STING-TBK1 complex and suppresses the NF-kappaB signaling pathway.J Virol 2024,98(3),e0181523. [17] Liu,Q.,et al.,Circulating mitochondrial DNA-triggered autophagy dysfunction via STING underlies sepsis-related acute lung injury.Cell Death Dis 2021,12(7),673.[18] Zhang,H.,et al.,Zixue Powder attenuates septic thrombosis via reducing neutrophil extracellular trap through blocking platelet STING activation.J Ethnopharmacol 2024,331,118337. [19] Xiong,W.,et al.,Cathelicidin-HG Alleviates Sepsis-Induced Platelet Dysfunction by Inhibiting GPVI-Mediated Platelet Activation.Research(Wash D C)2024,7,0381. [20] Zhu,S.,et al.,Neutrophil extracellular traps contribute to immunothrombosis formation via the STING pathway in sepsis-associated lung injury.Cell Death Discovery 2023,9(1). [21] Weiss,L.J.,et al.,Acquired platelet GPVI receptor dysfunction in critically ill patients with sepsis.Blood 2021,137(22),3105-3115. [22] Zhang,S.Y.,et al.,Soluble CD4 effectively prevents excessive TLR activation of resident macrophages in the onset of sepsis.Signal Transduct Target Ther 2023,8(1),236. [23] Patel,P.,et al.,Platelet FcgammaRIIA in immunity and thrombosis:Adaptive immunothrombosis.J Thromb Haemost 2021,19(5),1149-1160. [24] Mandel,J.,et al.,Beyond Hemostasis:Platelet Innate Immune Interactions and Thromboinflammation.Int J Mol Sci 2022,23(7). [25] Yao,B.,et al.,Usefulness of sialic acid for diagnosis of sepsis in critically ill patients:a retrospective study.BMC Anesthesiol 2020,20(1),277. [26] Shi,R.,et al.,ASGR1 promotes liver injury in sepsis by modulating monocyte-to-macrophage differentiation via NF-kappaB/ATF5 pathway.Life Sci 2023,315,121339. [27] 宋景春,et al.,脓毒症性凝血病诊疗中国专家共识(2024 版).解放军医学杂志 2024,49(11),1221-1236. [28] Zhou,Z.,et al.,Prognosis and rescue therapy for sepsis-related severe thrombocytopenia in critically ill patients.Cytokine 2020,136,155227. [29] Liu,Y.,et al.,Recombinant human thrombopoietin in critically ill patients with sepsis-associated thrombocytopenia:A clinical study.Int J Infect Dis 2020,98,144-149. [30] Zhang,J.,et al.,Efficacy and Safety of Recombinant Human Thrombopoietin on Sepsis Patients With Thrombocytopenia:A Systematic Review and Meta-Analysis.Front Pharmacol 2020,11,940. [31] Xie,Y.,et al.,Recombinant human thrombopoietin in alleviating endothelial cell injury in sepsis.J Intensive Med 2024,4(3),384-392. [32] Sun,J.,et al.,Repurposed drugs block toxin-driven platelet clearance by the hepatic Ashwell-Morell receptor to clear Staphylococcus aureus bacteremia.Sci Transl Med 2021,13(586). [33] Pan,B.,et al.,Efficacy of IVIG therapy for patients with sepsis:a systematic review and meta-analysis.J Transl Med 2023,21(1),765.

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