Yoh K, Kobayashi M, Hirayama A, Hirayama K, Yamaguchi N, Nagase S, Koyama A
Department of Internal Medicine, University of Tsukuba, Ibaraki, Japan.
Clin Nephrol. 1997 Nov;48(5):311-6.
A case in which the enterotoxins of Staphylococcus aureus may have served as bacterial superantigens is presented. This 71-year-old man developed proteinuria and renal dysfunction after contacting pneumonia caused by methicillin-resistant Staphylococcus aureus (MRSA), coagulase type II. The infection occurred after surgery for recurrent lung cancer. Staphylococcus enterotoxins B, C, and TSST-1 were detected from the bacillus. Ten days after the onset of pneumonia, proteinuria was noted; urinary protein was as high as 1.8 g/day. The serum creatinine was elevated from 1.0 mg/dl to 3.7 mg/dl. Several immunological reactions were detected; the serum levels of IgG and IgA were increased, and the selective usage of T-cell receptor V beta (TCRV beta) was observed. Serum levels of IL-1 beta, IL-2, IL-6, IL-8, IL-12, and tumor necrosis factor alpha (TNF alpha) were also elevated. Examination of the renal biopsy specimen by light microscopy showed minor to mild mesangial proliferative glomerulonephritis. Immunofluorescence microscopy demonstrated the deposition of IgG, IgA, and C3, mainly along the capillary walls. Electron microscopy revealed electron dense deposits, mainly in the subepithelial areas, and injury to the glomerular basement membrane. When the pneumonia improved following antibiotic therapy, the renal function also improved, and proteinuria decreased. The levels of immunoglobulins and the usage of TCRV beta also decreased. Because staphylococcus enterotoxins act as superantigens, we believe this to be a typical case of superantigen-related glomerulonephritis.
本文报道了一例金黄色葡萄球菌肠毒素可能作为细菌超抗原的病例。该71岁男性在感染由II型凝固酶的耐甲氧西林金黄色葡萄球菌（MRSA）引起的肺炎后出现蛋白尿和肾功能不全。感染发生在复发性肺癌手术后。从该菌中检测到了葡萄球菌肠毒素B、C和TSST-1。肺炎发病10天后发现蛋白尿；尿蛋白高达1.8g/天。血清肌酐从1.0mg/dl升至3.7mg/dl。检测到几种免疫反应；血清IgG和IgA水平升高，并观察到T细胞受体Vβ（TCRVβ）的选择性使用。血清白细胞介素-1β、白细胞介素-2、白细胞介素-6、白细胞介素-8、白细胞介素-12和肿瘤坏死因子α（TNFα）水平也升高。光镜检查肾活检标本显示轻度至中度系膜增生性肾小球肾炎。免疫荧光显微镜显示IgG、IgA和C3沉积，主要沿毛细血管壁。电镜显示电子致密沉积物，主要位于上皮下区域，以及肾小球基底膜损伤。抗生素治疗后肺炎好转时，肾功能也改善，蛋白尿减少。免疫球蛋白水平和TCRVβ的使用也降低。由于葡萄球菌肠毒素作为超抗原起作用，我们认为这是一例典型的超抗原相关肾小球肾炎病例。
