当前位置：首页 > 新闻动态 > 行业新闻新冠肺炎“炎症风暴”是近期公众关注的诸多热点话题之一；所谓“炎症风暴”即全身炎症反应综合征（SIRS），人体的炎症因子，不仅可以杀掉病毒，也会给自身造成损害，某些新冠患者后期可能突然启动了一个“炎症风暴”，结果导致各个器官的功能衰竭。那么应该如何应对“炎症风暴”呢？中南大学湘雅医学院林韶辉博士撰文“有效针对新冠肺炎的“炎症风暴”——Omega-3多不饱和脂肪酸”，表达了自己的一些观点，或许会给大家一些思考和启发。
一、新冠肺炎专家说
1. 武汉金银潭医院：上海中山医院重症医学科副主任钟鸣医生（2020年1月24到达武汉），2020年2月3日，南方人物周刊对钟医生进行独家专访，提到救治初期，所面临的困难之中，有的新冠患者后期可能突然启动了一个“炎症风暴”，这种炎症风暴导致了各个器官的功能衰竭，一旦进入这个状态，我们的治疗很难把它拉回来。
2. 武汉大学中南医院：《美国医学会杂志》2月7日在线发布了武汉大学中南医院重症监护室（ICU）主任彭志勇博士领衔的一项回顾性分析，研究团队认为，新冠肺炎致死的三大主要机制：
中性粒细胞增多，与细胞因子风暴有关；
D-二聚体升高反映凝血激活，提示持续的炎症反应；
血尿素升高提示急性肾损伤，这是感染、休克和缺氧的综合结果。
3. 种种迹象表明，这些重症患者中发生了不可逆转的“炎症风暴”。而一旦患者发生“炎症风暴”，糖皮质激素是对抗炎症风暴的武器之一，可以给免疫系统“灭火”，减轻机体损伤。不过，糖皮质激素是一把“双刃剑”。一方面它可以减轻炎症反应，有利于改善缺氧、呼吸窘迫症状；但长期大剂量使用也可能引发诸多不良反应。不少经过大剂量激素治疗的“非典”患者，都留下了如股骨头坏死等严重后遗症。
二、“炎症风暴”与Omega-3多不饱和脂肪酸
3. Omega-3 PUFA对抗炎症反应的作用机制
图1. 长链不饱和脂肪酸代谢示意图
4. 多种文献证明，为了减少患者还可能发生爆发性炎症反应，使用高纯度的 Omega-3 PUFA制剂，可以减低炎症风暴的发生风险。具体表现
4.1 Omega-3 PUFA富集于细胞膜，参与炎症反应调控过程，减少炎性细胞产生促炎性细胞因子；
Omega-3 PUFA富集于细胞膜，提高细胞膜EPA和DHA脂肪酸的比例[11, 12]，影响胞内信号传导，抑制炎症相关的转录因子NF-kappa B的转录活性[13, 14]，从而减少促炎性细胞因子TNF-alpha、IL-6 和IL-8等的表达[15]。
花生四烯酸类脂质经一系列酶催化产生促炎症调节作用的前列腺素（PGE2）和白三烯B4等。这些促炎性介质进而可激活中性粒细胞、巨噬细胞，刺激炎症细胞因子TNF-α、IL-1、IL-2、IL-8和干扰素（Interferon, IFN）等释放增多。Omega-3和Omega-6两类 PUFA竞争相同的脂肪酸代谢酶（Elovl5和FADS2）系统[16-18]，从而干扰促炎性介质的生成。
EPA和DHA经代谢产生消散素（Resolvins）和保护素（Protections）。实验研究证实，消散素和保护素在关节炎[19]、结肠炎[20]、哮喘[21, 22]等多种炎性疾病中发挥重要的抗炎作用[23, 24] 。例如，resolvin E1，resolvin D1和protectin D1能抑制浸润性中性粒细胞的细胞迁移，从而减轻局部炎症[24]。此外，resolvin D1和protectin D1还能抑制TNF-α and IL-1β的产生，从而减弱炎症反应[25, 26]。
5. Omega-3 PUFA缓解炎症的具体临床获益
5.1 C反应蛋白等炎症指标显著下降，血红蛋白和白细胞、血小板等细胞类群总量显著上升。
表1. ICU患者使用Omega-3 PUFA带来的生理指标和临床指标获益
5.2 败血症状明显下降，治疗用抗生素使用时间缩短，全身炎症反应综合征减少，器官功能障碍后遗症发生率减少，死亡率下降；
美国田纳西大学附属医院和西班牙多所医院的临床研究表明，对于重症创伤患者和脓毒症患者等ICU患者，每天1~3克Omega-3 PUFA营养液可以有效降低菌血症、败血症并发症发生（下降14%[29]~35%[30]），明显降低治疗用抗生素使用时间和腹腔内脓肿发生率[30]。而使用更高Omega-3 PUFA含量（4克以上）的营养液后，创伤病人全身炎症反应综合征发生人数显著下降[27]；脓毒症、败血症患者的器官功能障碍发生率减少达到43%[31]，死亡率显著下降13.1%[29]~19.4%[31]。
表2. 创伤患者和败血症患者使用Omega-3 PUFA的临床获益
5.3 改善氧合状态，减少呼吸机使用，缩短ICU监护时间；
6.2 生物利用度高，保证体内有效富集。
6.3 添加中链甘油三酯（MCTs），促进Omega-3 PUFA快速细胞富集，为重症患者的症状缓解赢得时间。添加MCT的Omega-3脂肪乳的体内富集时间更短（术后第六天即检测到病患血清磷脂和红细胞细胞膜中的EPA和DHA显著升高）[35]，激发免疫更强（第六天起外周血细胞释放的白三烯B5含量已增长约2倍）[36]；
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