《儿童难治性肺炎支原体肺炎rmpp诊治》.ppt

Unlike many bacterial pathogens, Mycoplasma pneumoniae is not known to produce classical toxins, and precisely how M. pneumoniae injures the respiratory epithelium has remained a mystery for 50 years. Here, we report the identification of a virulence factor (MPN372) possibly responsible for airway cellular damage and other sequelae associated with M. pneumoniae infections in humans. We show that M. pneumoniae MPN372 encodes a 68-kDa protein that possesses ADP-ribosyltransferase (ART) activity. Within its N terminus, MPN372 contains key amino acids associated with NAD binding and ADP-ribosylating activity, similar to pertussis toxin (PTX) S1 subunit (PTX-S1). Interestingly, MPN372 ADP ribosylates both identical and distinct mammalian proteins when compared with PTX-S1. Remarkably, MPN372 elicits extensive vacuolization and ultimate cell death of mammalian cells, including distinct and progressive patterns of cytopathology in tracheal rings in organ culture that had been previously ascribed to infection with WT virulent M. pneumoniae. We observed dramatic seroconversion to MPN372 in patients diagnosed with M. pneumoniae-associated pneumonia, indicating that this toxin is synthesized in vivo and possesses highly immunogenic epitopes. * 要点：地塞米松对HPA抑制更强 而相比而言 ，地塞米松早晨8点单剂给药，其对体内血浆17－羟类固醇的分泌不仅在当天就产生强烈抑制，同时这种抑制作用持续48小时以上。这使得地塞米松在长期使用时会导致肾上腺的萎缩，肾上腺功能的丧失。这一点对长期使用极其不利 ，因为其导致肾上腺的萎缩而增加症状改善后撤药的危险和疾病的反跳。而且一旦患者出现应激或突然停药，由于自身被抑制的HPA轴不能恢复功能而分泌糖皮质激素，將出现临床上的“肾上腺危象”，危及生命。 * 儿童社区获得性肺炎管理指南（2013修订）上 CAP抗菌药物疗程 SP肺炎疗程7~10d，HI肺炎、MSSA肺炎14d左右，MRSA肺炎疗程宜延长至21~28d，革兰阴性肠杆菌肺炎疗程14~21d，MP肺炎、CP肺炎疗程平均10~14d，个别严重者可适当延长，嗜肺军团菌肺炎21~28d 儿童难治性MP肺炎诊治的若干问题 早期足量抗MP治疗 MP对大环内酯类（Macrolides ,ML）耐药 全身激素的合理应用 大剂量丙球的合理应用 并发症的处理 支气管镜的介入治疗 混合感染 2002-2008年ML耐药MP菌株Japan Morozumi M,et al.J Infect Chemother,2010,16:78 北京地区MP菌株耐药状况 Xin D,et al.AAC,2009,53(5):2158 46/50(92%)对ML耐药 上海地区MP菌株耐药状况 44/53(83%)对ML耐药 Liu Y,et al.AAC,2009,53(5):2160 MP耐药对疗效的影响（日本） MP耐药 MP敏感 例数