中性粒细胞及血小板标志物在感染相关急性肺损伤早期诊断中的进展

文晓 甜(湖南师范大学附属第一医院, 李建 民*(湖南师范大学附属第一医院
湖南省人民医院）

摘要


急性肺损伤（ALI）及其严重表现形式急性呼吸窘迫综合征（ARDS）是重症监护病房（ICU）中最常见的
危重症之一，该病起病急、进展快、预后较差，严重威胁患者健康。在肺损伤尚未充分显现的早期阶段准确识别高
风险患者，有助于及时实施临床干预，因此早期诊断是感染相关ALI临床管理的重要环节。近年来，与中性粒细胞
和血小板活化相关的细胞标志物不断受到关注，理想标志物有望在影像学异常和氧合指标明显恶化前反映疾病相关
病理变化。因此，本文从中性粒细胞胞外陷阱（NETs）及其组分、中性粒细胞表面活化标志物、血小板活化标志物
及衍生微粒、血小板-白细胞聚集体、血小板与中性粒细胞相互作用和免疫血栓形成等方面，总结相关细胞标志物
在感染相关ALI早期诊断中的研究进展。现有证据提示，citH3、MPO-DNA、NE-DNA等NETs组分和血小板-单
核细胞聚集体（PMAs）具有一定的诊断潜力；CD64、CD11b/CD18、CXCL4及血小板衍生微粒（PMPs）等标志物
的临床价值仍需进一步验证。由于现有研究在人群、病因及检测方法等方面存在差异，未来仍需开展大样本、多中
心、前瞻性动态研究，并探索多标志物联合检测策略。本文可为感染相关ALI高风险患者的早期识别及相关细胞标
志物的临床转化研究提供参考。

关键词


急性肺损伤;急性呼吸窘迫综合征;中性粒细胞胞外陷阱;血小板活化;血小板-白细胞聚集体;免疫血;栓形成;生物标志物;早期诊断;综述;研究进展

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参考


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