當前位置：首頁 > 新聞動態 > 行業新聞新冠肺炎“炎癥風暴”是近期公眾關注的諸多熱點話題之一；所謂“炎癥風暴”即全身炎癥反應綜合征（SIRS），人體的炎癥因子，不僅可以殺掉病毒，也會給自身造成損害，某些新冠患者后期可能突然啟動了一個“炎癥風暴”，結果導致各個器官的功能衰竭。那么應該如何應對“炎癥風暴”呢？中南大學湘雅醫學院林韶輝博士撰文“有效針對新冠肺炎的“炎癥風暴”——Omega-3多不飽和脂肪酸”，表達了自己的一些觀點，或許會給大家一些思考和啟發。
一、新冠肺炎專家說
1. 武漢金銀潭醫院：上海中山醫院重癥醫學科副主任鐘鳴醫生（2020年1月24到達武漢），2020年2月3日，南方人物周刊對鐘醫生進行獨家專訪，提到救治初期，所面臨的困難之中，有的新冠患者后期可能突然啟動了一個“炎癥風暴”，這種炎癥風暴導致了各個器官的功能衰竭，一旦進入這個狀態，我們的治療很難把它拉回來。
2. 武漢大學中南醫院：《美國醫學會雜志》2月7日在線發布了武漢大學中南醫院重癥監護室（ICU）主任彭志勇博士領銜的一項回顧性分析，研究團隊認為，新冠肺炎致死的三大主要機制：
中性粒細胞增多，與細胞因子風暴有關；
D-二聚體升高反映凝血激活，提示持續的炎癥反應；
血尿素升高提示急性腎損傷，這是感染、休克和缺氧的綜合結果。
3. 種種跡象表明，這些重癥患者中發生了不可逆轉的“炎癥風暴”。而一旦患者發生“炎癥風暴”，糖皮質激素是對抗炎癥風暴的武器之一，可以給免疫系統“滅火”，減輕機體損傷。不過，糖皮質激素是一把“雙刃劍”。一方面它可以減輕炎癥反應，有利于改善缺氧、呼吸窘迫癥狀；但長期大劑量使用也可能引發諸多不良反應。不少經過大劑量激素治療的“非典”患者，都留下了如股骨頭壞死等嚴重后遺癥。
二、“炎癥風暴”與Omega-3多不飽和脂肪酸
3. Omega-3 PUFA對抗炎癥反應的作用機制
圖1. 長鏈不飽和脂肪酸代謝示意圖
4. 多種文獻證明，為了減少患者還可能發生爆發性炎癥反應，使用高純度的 Omega-3 PUFA制劑，可以減低炎癥風暴的發生風險。具體表現
4.1 Omega-3 PUFA富集于細胞膜，參與炎癥反應調控過程，減少炎性細胞產生促炎性細胞因子；
Omega-3 PUFA富集于細胞膜，提高細胞膜EPA和DHA脂肪酸的比例[11, 12]，影響胞內信號傳導，抑制炎癥相關的轉錄因子NF-kappa B的轉錄活性[13, 14]，從而減少促炎性細胞因子TNF-alpha、IL-6 和IL-8等的表達[15]。
花生四烯酸類脂質經一系列酶催化產生促炎癥調節作用的前列腺素（PGE2）和白三烯B4等。這些促炎性介質進而可激活中性粒細胞、巨噬細胞，刺激炎癥細胞因子TNF-α、IL-1、IL-2、IL-8和干擾素（Interferon, IFN）等釋放增多。Omega-3和Omega-6兩類 PUFA競爭相同的脂肪酸代謝酶（Elovl5和FADS2）系統[16-18]，從而干擾促炎性介質的生成。
EPA和DHA經代謝產生消散素（Resolvins）和保護素（Protections）。實驗研究證實，消散素和保護素在關節炎[19]、結腸炎[20]、哮喘[21, 22]等多種炎性疾病中發揮重要的抗炎作用[23, 24] 。例如，resolvin E1，resolvin D1和protectin D1能抑制浸潤性中性粒細胞的細胞遷移，從而減輕局部炎癥[24]。此外，resolvin D1和protectin D1還能抑制TNF-α and IL-1β的產生，從而減弱炎癥反應[25, 26]。
5. Omega-3 PUFA緩解炎癥的具體臨床獲益
5.1 C反應蛋白等炎癥指標顯著下降，血紅蛋白和白細胞、血小板等細胞類群總量顯著上升。
表1. ICU患者使用Omega-3 PUFA帶來的生理指標和臨床指標獲益
5.2 敗血癥狀明顯下降，治療用抗生素使用時間縮短，全身炎癥反應綜合征減少，器官功能障礙后遺癥發生率減少，死亡率下降；
美國田納西大學附屬醫院和西班牙多所醫院的臨床研究表明，對于重癥創傷患者和膿毒癥患者等ICU患者，每天1~3克Omega-3 PUFA營養液可以有效降低菌血癥、敗血癥并發癥發生（下降14%[29]~35%[30]），明顯降低治療用抗生素使用時間和腹腔內膿腫發生率[30]。而使用更高Omega-3 PUFA含量（4克以上）的營養液后，創傷病人全身炎癥反應綜合征發生人數顯著下降[27]；膿毒癥、敗血癥患者的器官功能障礙發生率減少達到43%[31]，死亡率顯著下降13.1%[29]~19.4%[31]。
表2. 創傷患者和敗血癥患者使用Omega-3 PUFA的臨床獲益
5.3 改善氧合狀態，減少呼吸機使用，縮短ICU監護時間；
6.2 生物利用度高，保證體內有效富集。
6.3 添加中鏈甘油三酯（MCTs），促進Omega-3 PUFA快速細胞富集，為重癥患者的癥狀緩解贏得時間。添加MCT的Omega-3脂肪乳的體內富集時間更短（術后第六天即檢測到病患血清磷脂和紅細胞細胞膜中的EPA和DHA顯著升高）[35]，激發免疫更強（第六天起外周血細胞釋放的白三烯B5含量已增長約2倍）[36]；
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