用于保护脓毒症中内皮糖萼完整性的有前景的治疗干预措施：一项系统综述。
完整摘要 · 中文译文
内皮糖萼（eGCX）降解是脓毒症中的主要病理生理事件，导致内皮功能障碍、血管通透性增加、炎症、微血管血栓形成和器官衰竭。尽管其重要性不言而喻，但针对eGCX的治疗目前尚未纳入脓毒症的标准管理。本系统综述总结了旨在保护或恢复脓毒症中eGCX完整性的治疗和实验策略的临床与临床前证据。检索了PubMed、Scopus、Web of Science、Cochrane Library和Google Scholar，截至2026年8月。符合条件的人体和动物研究评估了脓毒症或实验性脓毒症模型中针对eGCX的干预措施。结局包括循环生物标志物如 syndecan-1、硫酸乙酰肝素和透明质酸，微循环指标包括灌注边界区域，以及通过显微镜进行的结构评估。使用RoB 2、SYRCLE和ROBINS-I评估偏倚风险。共纳入21项研究，包括17项动物研究和4项人体研究。干预措施包括抗坏血酸、舒洛地特、多西环素、活化蛋白C、基于肝素的治疗、抗凝血酶、重组血栓调节蛋白、治疗性血浆置换、colivelin、预组装eGCX的脂质体纳米载体以及鼠李聚糖硫酸盐。若干干预措施减少了eGCX脱落，改善了内皮屏障或微血管功能，并且在一些实验模型中，保留或恢复了eGCX超微结构。总体而言，eGCX代表脓毒症中一个有前景的治疗靶点；然而，大多数证据仍处于临床前阶段，a 需要使用标准化eGCX结局指标的精心设计的临床研究。
完整摘要 · 英文原文
Endothelial Glycocalyx (eGCX) degradation is a major pathophysiological event in sepsis, contributing to endothelial dysfunction, vascular permeability, inflammation, microvascular thrombosis, and organ failure. Despite its importance, eGCX-targeted therapies are not currently incorporated into standard sepsis management. This systematic review summarized clinical and preclinical evidence on therapeutic and experimental strategies aimed at preserving or restoring eGCX integrity in sepsis. PubMed, Scopus, Web of Science, the Cochrane Library, and Google Scholar were searched through August 2026. Eligible human and animal studies evaluated eGCX-directed interventions in sepsis or experimental sepsis models. Outcomes included circulating biomarkers such as syndecan-1, heparan sulfate, and hyaluronan, microcirculatory measures including perfused boundary region, and structural assessment by microscopy. Risk of bias was assessed using RoB 2, SYRCLE, and ROBINS-I. Twenty-one studies were included, comprising 17 animal and 4 human studies. Interventions included ascorbic acid, sulodexide, doxycycline, activated protein C, heparin-based therapies, antithrombin, recombinant thrombomodulin, therapeutic plasma exchange, colivelin, liposomal nanocarriers of preassembled eGCX, and rhamnan sulfate. Several interventions reduced eGCX shedding, improved endothelial barrier or microvascular function, and, in some experimental models, preserved or restored eGCX ultrastructure. Overall, the eGCX represents a promising therapeutic target in sepsis; however, most evidence remains preclinical, and well-designed clinical studies using standardized eGCX outcomes are needed.