成人酿脓链球菌导致中毒休克综合征临床分析  

Clinical analysis of adults with toxic shock syndrome induced by Streptococcus pyogenes

作　　者：王澎[1] 杨启文[1] 周翔[1] 赵欣欣[1] 王瑶[1] 王贺[1] 徐英春[1] 刘大为[1] 

机构地区：[1]北京协和医院检验科微生物组,北京100730

出　　处：《中华医院感染学杂志》2016年第10期2251-2253,2259,共4页Chinese Journal of Nosocomiology

基　　金：卫计委公共卫生专项基金资助项目(201402001)

摘　　要：目的探讨酿脓链球菌导致毒素休克综合征的致病机制及患者死亡原因。方法研究2例侵袭性酿脓链球菌致坏死性筋膜炎并发毒素休克综合征患者临床资料,对其中1例患者的分离株进行emm基因分型及其超抗原毒素基因的测定。结果患者2感染酿脓链球菌(GAS)产生的emm89型M蛋白,并且同时产生多种超抗原毒素(speG、speI、speK/L、smeZ、ssa、spd1、spd3、spd4、sdn、prtF-15);病例1患者因昏迷、休克,而放弃治疗,病例2患者因多器官功能脏器衰竭死亡。结论我国首例报道由emm89型酿脓链球菌所致严重的侵袭性感染,坏死性筋膜炎伴毒素休克综合征,emm89型酿脓链球菌引起的重症感染应引起有关部门的足够重视,避免形成暴发流行,早期的手术清创以及有效的抗感染、IVIG的使用,是挽救患者的有效手段。OBJECTIVE To explore the pathogenic mechanisms of toxic shock syndrome caused by Streptococcus pyogenes and investigate the causes of death.METHODS Totally 2patients with necrotizing fasciitis complicated with toxic shock syndrome induced by invasive S.pyogenes were enrolled in the study,the clinical data of the subjects were observed,and the genotypes of emm89 and the superantigen toxin genes were determined for the strains isolated from one of the patients.RESULTS The S.pyogenes isolated from patient 2produced emm89/M protein and a variety of superantigen toxins（speG,speI,speK/L,smeZ,ssa,spd1,spd3,spd4,sdn,prtF-15）.The patient 1abnadoned the treatment due to coma and shock;the patient 2died of failure of function of multiple oragans.CONCLUSIONIt is for the first time in China to report the case of severe invasive infection,necrotizing fasciitis complicated with toxic shock syndrome caused by the emm89 S.pyogenes.The corresponding institutions should attach great importance to the severe infection caused by the emm89 S.pyogenes so as to avoid the outbreak and prevalence.The early surgical debridement,effective anti-infection therapies,and IVIG are effective measures to save the patients.

关 键 词：酿脓链球菌 A群链球菌 坏死性筋膜炎 毒素休克综合征 链球菌毒素休克综合征 emm89基因 

分 类 号：R378.12[医药卫生—病原生物学]