mrsa肺炎的诊治进展课件.ppt

MRSA肺炎的诊治进展

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MRSA肺炎的危险因素

;MRSA肺炎的危险因素;MRSA肺炎的临床与X线特征;;MRSA肺炎的常见影像学表现;肺气囊;;;金黄色葡萄球菌肺炎X线表现以毛玻璃征最常见。

其他依次为支气管壁增厚、小叶中心结节〔树呀征或边界不清的小结节〕、实变、网状斑块、支气管扩张、小叶间隔增厚、空洞、结节和胸积液。

但最特征的影像学表现为肺气囊。;;胸部HRCT;治疗经过;;出院时情况;;

Staphylococcalenterotoxinsareknowntoactassuperantigens.SuperantigenscanbinddirectlytomajorhistocompatibilitycomplexclassIIonantigen-presentingcellsandarerecognizedbyTcellreceptor(TCR).TheybindonlytoVβchainontheTCR,andcausemassiveactivationofTcellsand

subsequentreleaseofTcell-derivedcytokines,suchasIL-2,TNFandINF-y.;ThepathogenesisofMRSA-GNisspeculated

asfollows;long-terminfectionofMRSAleadstotheproductionofStaphylococcalenterotoxinsandthesesubstancesactassuperantigens.ThatcausesmassiveTcellactivationandreleasedcytokinesinducekidneyinjuriesincludingtubulointerstitialnephritis.

ThecytokinesalsocausepolyclonalBcellactivationthatleadstotheformationofimmunecomplex,resultinginglomerulonephritis.

MostcaseswithMRSA-GNrevealrapidlyprogressiveglomerulonephritiswithvariousdegreesofproteinuriaandelevationofserumIgAandIgG;

Inadditiontothesuperantigen-relatedglomerulonephritis,staphylococcalinfectionsassociatedwithglomerulonephritishavebeenreported:bacteremiaassociatedwithinfected

ventriculoatrialshunt,bacteremiaassociatedwithendocarditis,andglomerularlesionassociatedwithvisceralabcesses.

Inthesecases,thelevelofcomplementislow,cryoglobulinsarefrequent,andtheelevatedimmunoglobulintypeisIgGbutnotIgA.;;;;;;金黄色葡萄球菌;

金黄色葡萄球菌肺炎的临床表现复杂多样，可以通过多种机制导致急性肾功能受损。对此，临床医生必须予以高度重视。

;;;随机、双盲、多中心研究，共入组611例病人;;YoshizawaS,etal.AntimicrobAgentsChemother,2021;56(4):1744-1748.;;;YoshizawaS,etal.AntimicrobAgentsChemother,2021;56(4):1744-1748.;YoshizawaS,etal.AntimicrobAgentsChemother,2021;56(4):1744-1748.;;YoshizawaS,et