Chaisri U, Nagata M, Kurazono H, Horie H, Tongtawe P, Hayashi H, Watanabe T, Tapchaisri P, Chongsa-nguan M, Chaicumpa W
Department of Microbiology and Immunology, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
Microb Pathog. 2001 Aug;31(2):59-67. doi: 10.1006/mpat.2001.0447.
Haemolytic uraemic syndrome (HUS) is characterized by haemolytic anaemia, thrombocytopenia and renal failure. Infection with enterohaemorrhagic Escherichia coli (EHEC), mainly O157:H7, has been strongly implicated as the major cause of HUS in children. The pathogenesis of HUS caused by the infection is not well understood and the defined sites of Stx in kidney of EHEC-infected humans has not been clearly demonstrated. The aim of this study was to investigate and compare the locations of Stx deposition in kidneys of paediatric and geriatric patients who died from enterohaemorrhagic E. coli O157 (EHEC) associated HUS, using an immunoperoxidase staining of the tissues. The study revealed that binding of Stx was relatively less and limited only to the renal tubules of an adult case (81 years old), while more binding was found at both renal tubules and glomeruli of an infant case (21 months old). The Stx binding in the infant's glomeruli was at podocytes, mesangial and endothelial cells. It has been known that young children are more susceptible than adults to HUS. One possibility for this is that the more extensive binding of the Stx to the kidney tissue of the paediatric patient might be due to the higher synthesis and expression of Stx receptors, i.e. Gb(3), in infants and less so in the aged individuals. However, other alternatives are possible, for example, the difference in stage of HUS in individual patients. Thus it is too early to draw any conclusion on this enigma and further investigation is required.
溶血性尿毒综合征（HUS）的特征为溶血性贫血、血小板减少和肾衰竭。肠出血性大肠杆菌（EHEC）感染，主要是O157:H7感染，被强烈认为是儿童HUS的主要病因。由该感染引起的HUS的发病机制尚未完全明确，EHEC感染人类后志贺毒素（Stx）在肾脏中的具体定位也未得到清晰证实。本研究的目的是通过对组织进行免疫过氧化物酶染色，调查并比较死于肠出血性大肠杆菌O157（EHEC）相关HUS的儿科和老年患者肾脏中Stx沉积的位置。研究发现，在一例成年病例（81岁）中，Stx的结合相对较少且仅局限于肾小管，而在一例婴儿病例（21个月大）的肾小管和肾小球中均发现了更多的结合。婴儿肾小球中的Stx结合发生在足细胞、系膜细胞和内皮细胞。已知幼儿比成人更容易患HUS。一种可能性是，Stx在儿科患者肾脏组织中的更广泛结合可能是由于婴儿中Stx受体即Gb(3)的合成和表达较高，而在老年人中则较少。然而，也可能有其他原因，例如个体患者HUS阶段的差异。因此，就这个谜团得出任何结论还为时过早，需要进一步调查。
