化脓链球菌致中毒性休克综合征临床分析  

Analysis of toxic shock syndrome caused by Streptococcus pyogenes

作　　者：宁兴旺[1] 朱惠斌[1] 钱纯[1] 邓兰平[1] 谢小兵[1] 

机构地区：[1]湖南中医药大学第一附属医院医学检验中心,长沙410007

出　　处：《检验医学与临床》2017年第23期3444-3446,共3页Laboratory Medicine and Clinic

基　　金：湖南省教育厅科学研究资助项目(17B195)

摘　　要：目的了解化脓链球菌致中毒性休克综合征(STSS)的实验室检查特征,为临床诊治和流行病学调查提供参考依据。方法回顾性分析1例化脓链球菌感染致STSS患者的临床诊治经过和实验室检查数据,对分离株进行emm基因分型,并检测其常见超抗原基因。结果该患者因左脚趾皮肤溃破致左下肢严重感染,并伴多器官功能衰竭及STSS。伤口分泌物分离出化脓链球菌,对青霉素敏感。分离株为emm 1.1型,携带speA、speC、spek、ssa和smeZ等5种超抗原基因。临床采取清创、负压封闭引流技术(VSD)和青霉素联合克林霉素抗感染等综合治疗,患者痊愈出院。结论化脓链球菌致STSS可引起严重的临床症状,与其携带多种超抗原基因有关。外科治疗和有效抗感染是保证治疗成功的关键。Objective To reveal the laboratory characteristics of toxic shock syndrome（STSS）caused by Streptococcus pyogenes,and to provide new evidences for clinical diagnosis and epidemiological investigation.Methods We retrospectively reviewed a case with STSS caused by Streptococcus pyogenes,including the course of diagnosis and therapy,laboratory data,emm genotyping for the isolate,and the superantigen detection.Results The patient suffered from a severe infection on the left lower limb due to skin ulceration of her left toes,accompanied by multiple organ failure and STSS.Streptococcus pyogenes strains were isolated from the wound secretion;the isolates were sensitive to penicillin.The genotype was emm1.1,carrying genes for superantigens,including speA,speC,spek,ssa and smeZ.The therapeutic strategy for the patient included debridement,vacuum sealing drainage,and penicillin combined with clindamycin for infection control.The symptoms were improved obviously.Conclusion The severe clinical symptoms of STSS caused by Streptococcus pyogenes may associate with the superantigen gene carried by the isolate.Surgical treatment and infection control may play a vital role in patients whose features similar with this case.

关 键 词：化脓链球菌 中毒性休克综合征 emm基因 超抗原 

分 类 号：R631.4[医药卫生—外科学]