Department of Obstetrics and Gynaecology, AZ Sint Jan, Brugge-Oostende, Belgium.
Gynecol Obstet Invest. 2012;73(1):82-8. doi: 10.1159/000333233. Epub 2011 Dec 16.
Puerperal group A streptococcus (GAS) infection, once the leading cause of postpartum sepsis, has been increasing again since the 1980s. Streptococcal toxic shock syndrome (STSS) is a serious complication characterized by rapidly spreading GAS infection, shock, and multiple organ failure. Immediate recognition and implementation of therapy is crucial for survival. Making informed decisions regarding surgical debridement, namely hysterectomy, based on clinical indicators is difficult for practitioners.
This article discusses the potential role of creatine kinase in the decision-making process for treatment of STSS, particularly with regard to hysterectomy.
A case report is presented. The literature was searched using the key words 'group A streptococcus', 'postpartum hysterectomy', 'creatine kinase', 'endomyometritis', and 'streptococcal toxic shock syndrome' in PubMed and the UptoDate database. Relevant articles published between 1991 and 2011 were evaluated.
Decisions regarding hysterectomy in STSS management are difficult. A rise in CK levels in the serum may indicate involvement of the myometrium and may be an important parameter in the difficult decision of hysterectomy when treating STSS.
A 组链球菌（GAS）产后感染曾是导致产后败血症的主要原因，自 20 世纪 80 年代以来再次呈上升趋势。链球菌中毒性休克综合征（STSS）是一种严重的并发症，其特征是 GAS 感染迅速扩散、休克和多器官衰竭。及时识别和实施治疗对生存至关重要。对于临床医生来说，根据临床指标做出关于外科清创术（即子宫切除术）的决策是困难的。
本文讨论了肌酸激酶在 STSS 治疗决策中的潜在作用，特别是在子宫切除术中的作用。
呈现了一个病例报告。在 PubMed 和 UpToDate 数据库中使用关键词“group A streptococcus”、“postpartum hysterectomy”、“creatine kinase”、“endomyometritis”和“streptococcal toxic shock syndrome”检索文献，并评估了 1991 年至 2011 年之间发表的相关文章。
STSS 管理中子宫切除术的决策很困难。血清中 CK 水平的升高可能表明肌层受累，并且在治疗 STSS 时，对于子宫切除术这一困难决策可能是一个重要的参数。
