【作者】 纪宏丽；

【导师】 陈佰义；

【作者基本信息】 中国医科大学 ， 内科学， 2010， 硕士

【摘要】 目的肺炎克雷伯杆菌是临床上最常见的革兰阴性杆菌,是引起医院获得性泌尿系统感染、医院获得性肺炎和腹腔感染的重要病原体。近年来亚洲地区的研究发现了社区获得性肺炎克雷伯杆菌感染的另一个侵袭性感染的表现形式,即原发性肝脓肿伴菌血症,并且以肺炎克雷伯杆菌的血清型K1、K2型致病为主。肺炎克雷伯杆菌荚膜较厚,多糖物质丰富,使其可以对抗嗜中性白细胞之吞噬作用而致病,同时具有抗血清杀菌(即补体系统)的能力,故荚膜是肺炎克雷伯杆菌致病的毒力因子。根据荚膜多糖结构及抗原性的不同,可将肺炎克雷伯杆菌分为80多个荚膜血清型。其中K1、K2型肺炎克雷伯杆菌的抗嗜中性白细胞之吞噬作用及抗细胞内杀伤作用强于非K1、K2型,因此,K1、K2型流行率较高,毒性较强。目前国内关于肺炎克雷伯杆菌的药敏、耐药情况以及ESBLs表型检测等方面报道较多,而血清型检测、分布及相关研究少见。因此本实验探讨辽宁沈阳地区肺炎克雷伯杆菌血清型分布及其在临床疾病中的分布情况。方法抽取中国医科大学附属第一医院检验科微生物室2008年至2009年10月间鉴定并保存的149株肺炎克雷伯杆菌临床菌株,其中42株来源于痰,37株来源于血,24株来源于尿,13株来源于脓汁,11株来源于分泌物,9株来源于引流液,7株来源于胆汁,6株来源于其他(包括胸水、导管各1株,腹水、脑脊液各2株)。经过传代、培养之后提取其DNA,通过对DNA的聚合酶链反应(PCR)来检测肺炎克雷伯杆菌血清型K1、K2的分布情况,即通过测定碱基序列的方法确定血清型。同时结合临床资料分析其在临床疾病即肝脓肿与非肝脓肿疾病中的分布情况。结果结合临床资料发现这149株标本中来源于肝脓肿的标本仅为11株,所占比例为7.38%；而来源于其他疾病包括呼吸系统疾病、循环系统疾病、消化系统疾病、血液系统疾病、泌尿系统疾病、神经系统疾病等(例如脾占位病变合并感染、足坏疽的分泌物、软组织感染、坏死性筋膜炎、胆囊结石伴胆囊炎、急性腹膜炎、脑出血病人并发尿路感染或肺内感染、颅内感染以及肿瘤病人并发各部位感染)即非肝脓肿的标本为138株,所占比例为92.62%。经检测,这149株肺炎克雷伯杆菌标本中K1、K2的阳性率仅为3.36%。其中有3株为血清型K1型,2株为血清型K2型。血清型为K1型的三株标本来源于胆囊结石、慢性胆囊炎患者的胆汁培养,肝硬化、自发性腹膜炎患者的血培养和吸入性肺炎患者的痰培养；血清型为K2型的两株标本来源于糖尿病肛管直肠周围脓肿患者的脓汁培养和脾海绵状血管瘤患者的引流液培养。而其他标本既不是血清型K1型,也不是血清型K2型。即138株非肝脓肿来源的肺炎克雷伯杆菌标本中有133株为非K1、K2型,所占比例高达96.38%。结论本研究提示本地区近两年非肝脓肿来源的肺炎克雷伯杆菌的血清型不以K1、K2为主。更多还原

【Abstract】 ObjectiveKlebsiella pneumoniae is the most common clinical Gram-negative bacteria, is causing hospital-acquired urinary tract infections, hospital acquired pneumonia and abdominal infections important pathogens. In recent years, the study found Asian community-acquired Klebsiella pne umoniae infection in another form of invasive infection, primary liver abscess with bacteremia, and Klebsiella pneumoniae serotype K1, K2-type main disease.Klebsiella pneumoniae capsular thick, rich in sugars, so that it can fight and phagocytosis by neutrophils and disease, but also has anti-serum bactericidal (ie the complement system) capability, it is Klebsiella pneumoniae capsule virulence factors of pathogenic bacteria. According to capsular polysaccharide antigens of different structure and can be divided into more than 80 Klebsiella pneumoniae capsular serotypes. Where K1, K2 Klebsiella pneumoniae anti-type neutrophils and phagocytosis and intracellular killing effect against stronger than non-K1, K2 type, therefore, K1, K2-based prevalence of high toxic. Currently on the susceptibility of Klebsiella pneumoniae, drug resistance and phenotypic detection of ESBLs reported more areas, while serotype detection, distribution and research rare. This study investigated Klebsiella pneumoniae serotype distribution and the distribution of clinical disease of Shengyang Liaoning Province.MethodsThe first affiliated hospital of China medical university selected microorganism room in 2008 to 2009 October identification and preservation of 149 strains Klebsiella pneumoniae isolates, including 42 from sputum,37 from blood,24 sources in urine,13 from pus,11 from discharge, nine from drainage fluid, seven from bile, six from other (including pleural effusion, a catheter, ascites, cerebrospinal fluid the two). After many generations, and the ability to extract DNA, DNA polymerase chain reaction (PCR) to detect Klebsiella pneumoniae serotypesKlorK2. And clinical data analysis combined with clinical disease in the liver abscess and non-liver abscess in the distribution of disease.ResultClinical data found that only 11 was from the liver abscess of the 149 specimens,accounted for 7.38%. But from other diseases, including respiratory diseases, circulatory diseases, digestive diseases, blood diseases, urinary system diseases, nervous system diseases. (For example, the splenic space-occupying lesions co-infected, gangrene of secretions, soft tissue infections, Necrotizing Fasciitis, gallbladder stones with cholecystitis, acute peritonitis, cerebral hemorrhage in patients with urinary tract infection or lung infection, intracranial infections and cancer patients with various site infection) That non-liver abscess 138, accounted for 92.62%.After detection of 149 strains Klebsiella pneumoniae specimens, K1, K2 of the positive rate was 3.36% include3 lines to serotypesKl,2 strains to serotypes K2.The serotypesKl are derived from the gallbladder stones, chronic cholecystitis bile culture; cirrhosis, spontaneous bacterial peritonitis in patients with blood culture and aspiration pneumonia patients of phlegm. The serotypes K2 are derived from diabetes patients with perirectal abscess of the nongzhi culture and spleen cavernous hemangiomas patients drainage broth. The other specimen is neither serotype K1 type, nor serotype K2 type. The 138 non-liver abscess from Klebsiella pneumoniae was detected in 133 non-K1, K2, their share as high as 96.38%ConclusionThese findings suggest that non-liver abscess in this region the source of Klebsiella pneumoniae serotypes not in K1, K2-based.更多还原