大肠杆菌毒力因子与急性肾衰竭有关。

B Kreft, H Pagel
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引用次数: 7

摘要

背景:急性肾功能衰竭(ARF)的发生显著提高革兰氏阴性脓毒性休克患者的死亡率。不同于脂多糖(LPS)的特异性细菌毒力因子在感染性休克肾功能恶化中的作用尚不清楚。方法:从尿路感染患者中分离大肠杆菌野生型菌株(536/21 WT, O6:K15:H31)。该菌株表达由致病岛遗传编码的多种毒力因子(如溶血素、菌毛)。自发缺失突变体536/21 Del缺乏这些毒力因子的表达。分别以5 × 10(4)/ml菌株或对照灌注液的悬液灌注离体大鼠肾脏,分析肾脏功能参数。免疫组织学和革兰氏染色检测大肠杆菌肾内沉积。结果:用尿路致病性大肠杆菌野生型菌株(536/21 WT)灌注离体大鼠肾脏可引起肾功能的急性恶化,而在暴露于缺乏毒力因子表达的大肠杆菌536/21缺失突变体的肾脏中未观察到这种情况。只有在大肠杆菌野生型菌株灌注的肾脏中,肾小球滤过率和尿流率显著降低,而在缺失突变体灌注的肾脏中,与对照组相比没有变化。结论:不同于LPS的不同细菌毒力因子如溶血素和不同菌毛的存在可能与大肠杆菌脓毒症ARF的发生有关。抗lps策略可能不足以降低革兰氏阴性败血性休克中ARF的风险。
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Virulence factors of Escherichia coli contribute to acute renal failure.

Background: The development of acute renal failure (ARF) significantly enhances the mortality of patients with Gram-negative septic shock. The role of specific bacterial virulence factors different from lipopolysaccharides (LPS) in the deterioration of renal function in septic shock remains to be determined.

Methods: An Escherichia coli wild-type strain (536/21 WT, O6:K15:H31) was isolated from a patient suffering from a urinary tract infection. The strain expresses various virulence factors (e.g. hemolysin, fimbriae) genetically encoded by pathogenicity islands. The spontaneous deletion mutant 536/21 Del lacks the expression of these virulence factors. Isolated rat kidneys were perfused with a suspension (5 x 10(4)/ml) of the respective strain or control perfusion medium and the renal functional parameters were analyzed. Intrarenal deposition of E. coli was detected by immunohistology and Gram staining.

Results: The perfusion of the isolated perfused rat kidney with a uropathogenic E. coli wild-type strain (536/21 WT) caused an acute deterioration of renal function which was not observed in kidneys exposed to a deletion mutant of E. coli 536/21 lacking the expression of virulence factors. The glomerular filtration rate and the urine flow rate significantly decreased only in kidneys perfused with the E. coli wild-type strain, while there was no change versus controls in kidneys perfused with the deletion mutant.

Conclusions: Distinctive bacterial virulence factors different from LPS such as hemolysin and the presence of different fimbriae may contribute to the development of ARF in sepsis induced by E. coli. Anti-LPS strategies may not be sufficient to reduce the risk of ARF in Gram-negative septic shock.

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