感染与血栓性微血管病  

Infection and thrombotic microangiopathy

作　　者：杨艳丽[1] 张莉芸[1] YANG Yan-li;ZHANG Li-yun(Department of Rheumatology,Third Hospital of Shanxi Medical University,Shanxi Bethune Hospital,Shanxi Academy of Medical Sciences,Tongji Shanxi Hospital,Taiyuan 030032,China)

机构地区：[1]山西医科大学第三医院(山西白求恩医院、山西医学科学院、同济山西医院)风湿免疫科,山西太原030032

出　　处：《中国实用内科杂志》2023年第6期446-449,共4页Chinese Journal of Practical Internal Medicine

基　　金：山西省医学科技创新团队(2020TD10)。

摘　　要：血栓性微血管病(TMA)是一组以微血管栓塞为病理特征的疾病,约33%的继发性TMA为感染导致,主要发病机制为不受控制的补体激活,其次直接的内皮损伤、含Ⅰ型血小板结合蛋白基序的解聚蛋白样金属蛋白酶(ADAMTS13)抗体的产生以及遗传和环境易感性均参与其中。各种细菌及病毒感染均可诱发TMA,常见的细菌感染为革兰氏阴性杆菌,病毒感染以巨细胞病毒和EB病毒多见。重症感染容易导致血小板下降、脓毒血症、弥散性血管内凝血等,与TMA表现重叠,诊断较为困难。在临床工作中,对于有贫血、血小板减少及多器官功能衰竭的重症感染患者,应该引起高度重视,警惕合并TMA,及时诊断及治疗,改善患者预后。Thrombotic microangiopathy(TMA)is a group of diseases characterized by microvascular embolism.About 33%of secondary TMA are caused by infection.The main pathogenesis is uncontrolled complement activation,followed by direct endothelial injury,ADAMTS13 antibody production,and genetic and environmental predisposition.A variety of bacterial and viral infections can induce TMA.Gram-negative bacilli are the most common in bacterial infections,and cytomegalovirus and Epstein-Barr virus are the most common in viral infections.Severe infection is prone to thrombocytopenia,sepsis,disseminated intravascular coagulation,etc.,which overlap with the manifestations of TMA,making diagnosis difficult.In clinical work,for severe infection patients with anemia,thrombocytopenia and multiple organ failure,we should be highly alert to the combination of TMA,and give timely diagnosis and treatment to improve the prognosis of patients.

关 键 词：血栓性微血管病 血栓性血小板减少性紫癜 溶血尿毒综合征 感染 

分 类 号：R692[医药卫生—泌尿科学]