引起肝脓肿的肺炎克雷伯菌毒力因子研究进展

doi:10.3969/j.issn.1673-8640.2018.09.016

摘要/Abstract

摘要：

肝脓肿是由溶组织阿米巴原虫或细菌引起的肝内化脓性感染灶,是常见的消化系统疾病,致死率较高。目前,细菌性肝脓肿的主要病原菌为肺炎克雷伯菌。肺炎克雷伯菌的致病性与其荚膜多糖、脂多糖、铁摄取系统和菌毛等毒力因子关系密切,引起肝脓肿的肺炎克雷伯菌通常为高毒力菌株,文章对肺炎克雷伯菌引起的肝脓肿（KLA）的主要毒力因子作一综述。

关键词: 肺炎克雷伯菌, 肝脓肿, 毒力因子

Abstract:

Liver abscess is a pyogenic infection of the liver which is usually caused by amoeba histolytica or bacteria. It is a common digestive system disease and has a high fatality rate. Nowadays,Klebsiella pneumoniae has emerged as the main pathogen of bacterial liver abscess. Virulence factors,which contribute to the pathogenicity of Klebsiella pneumoniae, are identified,such as capsular polysaccharides,lipopolysaccharides,iron uptake system and fimbriae. Klebsiella pneumoniae liver abscess（KLA） is usually caused by hypervirulent strains. Here,the main virulence factors of KLA are summarized.

Key words: Klebsiella pneumoniae, Liver abscess, Virulence factor

中图分类号:

R446.5

管红艳, 刘瑛. 引起肝脓肿的肺炎克雷伯菌毒力因子研究进展[J]. 检验医学, 2018, 33(9): 839-843.

GUAN Hongyan, LIU Ying. Research progress in the virulence factors of Klebsiella pneumoniae liver abscess[J]. Laboratory Medicine, 2018, 33(9): 839-843.

参考文献 38

[1]	TIAN L, TAN R,CHEN Y,et al.Epidemiology of Klebsiella pneumoniae bloodstream infections in a teaching hospital: factors related to the carbapenem resistance and patient mortality[J]. Antimicrob Resist Infect Control, 2016, 5:48.
[2]	QIAN Y, WONG C C,LAI S, et al.A retrospective study of pyogenic liver abscess focusing on Klebsiella pneumoniae as a primary pathogen in China from 1994 to 2015[J]. Sci Rep,2016,6:38587.
[3]	CHUANG C,FAN W C,LIN Y T,et al.The emergence of Klebsiella pneumoniae liver abscess in non-diabetic patients and the distribution of capsular types[J]. Gut Pathog, 2016, 8:46.
[4]	SHON A S,BAJWA R P,RUSSO T A.Hypervirulent (hypermucoviscous) Klebsiella pneumoniae: a new and dangerous breed[J]. Virulence, 2013, 4(2):107-118.
[5]	LIU L,CHEN W, LU X,et al.Pyogenic liver abscess: a retrospective study of 105 cases in an emergency department from east China[J]. J Emerg Med, 2017, 52(4):409-416.
[6]	GUO Y,WANG S,ZHAN L,et al.Microbiological and clinical characteristics of hypermucoviscous Klebsiella pneumoniae isolates associated with invasive infections in China[J]. Front Cell Infect Microbiol, 2017, 7:24.
[7]	CHEN Y C,LIN C H,CHANG S N,et al.Epidemiology and clinical outcome of pyogenic liver abscess: an analysis from the National Health Insurance Research Database of Taiwan, 2000-2011[J]. J Microbiol Immunol and Infect, 2016, 49(5):646-653.
[8]	叶李铭, 麦丽婷, 黄静. 高毒力肺炎克雷伯杆菌的临床特征和高毒力机制[J]. 国际呼吸杂志, 2017, 37(3):221-226.
[9]	FAZILI T,SHARNGOE C,ENDY T,et al.Klebsiella pneumoniae liver abscess: an emerging disease[J]. Am J Med Sci,2016,351(3):297-304.
[10]	贾艳,孙长江,韩文瑜, 等. 肺炎克雷伯菌研究进展[J]. 微生物学杂志, 2006,26(5):75-78.
[11]	YEH K M,CHIU S K,LIN C L,et al.Surface antigens contribute differently to the pathophysiological features in serotype K1 and K2 Klebsiella pneumoniae strains isolated from liver abscesses[J]. Gut Pathog, 2016, 8:4.
[12]	LIN J C,CHANG F Y, FUNG C P,et al.High prevalence of phagocytic-resistant capsular serotypes of Klebsiella pneumoniae in liver abscess[J]. Microbes Infect, 2004, 6(13):1191-1198.
[13]	FUNG C P,CHANG F Y,LIN J C, et al.Immune response and pathophysiological features of Klebsiella pneumoniae liver abscesses in an animal model[J]. Lab Invest, 2011, 91(7):1029-1039.
[14]	LUO Y,WANG Y,YE L,et al.Molecular epidemiology and virulence factors of pyogenic liver abscess causing Klebsiella pneumoniae in China[J]. Clin Microbiol Infect,2014,20(11):O818-O824.
[15]	YU W L,LEE M F,TANG H J,et al.Low prevalence of rmpA and high tendency of rmpA mutation correspond to low virulence of extended spectrum β-lactamase-producing Klebsiella pneumoniae isolates[J]. Virulence, 2015, 6(2):162-172.
[16]	HSU C R,LIN T L,CHEN Y C,et al.The role of Klebsiella pneumoniae rmpA in capsular polysaccharide synthesis and virulence revisited[J]. Microbiology, 2011, 157(Pt 12):3446-3457.
[17]	YU W L,LEE M F,CHEN C C,et al.Impacts of hypervirulence determinants on clinical features and outcomes of bacteremia caused by extended-spectrum β-lactamase-producing Klebsiella pneumoniae[J]. Microb Drug Resist,2017,23(3):376-383.
[18]	TANG H L,CHIANG M K,LIOU W J,et al.Correlation between Klebsiella pneumoniae carrying pLVPK-derived loci and abscess formation[J]. Eur J Clin Microbiol Infect Dis,2010,29(6):689-698.
[19]	WON S Y,MUNOZ-PRICE L S,LOLANS K,et al. Emergence and rapid regional spread of Klebsiella pneumoniae carbapenemase-producing Enterobacteriaceae[J]. Clin Infect Dis,2011,53(6):532-540.
[20]	FANG C T,LAI S Y,YI W C,et al.The function of wzy_K1 (magA), the serotype K1 polymerase gene in Klebsiella pneumoniae cps gene cluster[J]. J Infect Dis, 2010, 201(8):1268-1269.
[21]	FANG C T,CHUANG Y P,SHUN C T, et al.A novel virulence gene in Klebsiella pneumoniae strains causing primary liver abscess and septic metastatic complications[J]. J Exp Med, 2004, 199(5):697-705.
[22]	HSIEH P F,LIN T L,LEE C Z,et al.Serum-induced iron-acquisition systems and TonB contribute to virulence in Klebsiella pneumoniae causing primary pyogenic liver abscess[J]. J Infect Dis, 2008, 197(12):1717-1727.
[23]	FANG C T,SHIH Y J,CHEONG C M,et al.Rapid and accurate determination of lipopolysaccharide O-antigen types in Klebsiella pneumoniae with a novel PCR-based O-genotyping Method[J]. J Clin Microbiol, 2016, 54(3):666-675.
[24]	GARÉNAUX A,CAZA M,DOZOIS C M. The ins and outs of siderophore mediated iron uptake by extra-intestinal pathogenic Escherichia coli[J]. Vet Microbiol, 2011, 153(1-2):89-98.
[25]	SCHUBERT S,PICARD B,GOURIOU S,et al.Yersinia high-pathogenicity island contributes to virulence in Escherichia coli causing extraintestinal infections[J]. Infect Immun, 2002, 70(9):5335-5337.
[26]	HANCOCK V,FERRIÈRES L,KLEMM P. The ferric yersiniabactin uptake receptor FyuA is required for efficient biofilm formation by urinary tract infectious Escherichia coli in human urine[J]. Microbiology, 2008, 154(Pt 1):167-175.
[27]	MIZUTA K,OHTA M,MORI M,et al.Virulence for mice of Klebsiella strains belonging to the O1 group: relationship to their capsular (K) types[J]. Infect Immun, 1983, 40(1):56-61.
[28]	NASSIF X,SANSONETTI P J.Correlation of the virulence of Klebsiella pneumoniae K1 and K2 with the presence of a plasmid encoding aerobactin[J]. Infect Immun, 1986, 54(3):603-608.
[29]	陈杨,刘嘉琳,瞿洪平. 铁载体对肺炎克雷伯菌毒力增强的机制研究[J]. 中国感染与化疗杂志, 2016, 16(6):804-807.
[30]	ACHARD M E,CHEN K W,SWEET M J,et al.An antioxidant role for catecholate siderophores in Salmonella[J]. Biochem J, 2013, 454(3):543-549.
[31]	CHEN Y T,CHANG H Y,LAI Y C,et al.Sequencing and analysis of the large virulence plasmid pLVPK of Klebsiella pneumoniae CG43[J]. Gene, 2004, 337:189-198.
[32]	BRAUN V.Energy-coupled transport and signal transduction through the gram-negative outer membrane via TonB-ExbB-ExbD-dependent receptor proteins[J]. FEMS Microbiol Rev,1995,16(4):295-307.
[33]	LEE I R,MOLTON J S,WYRES K L,et al.Differential host susceptibility and bacterial virulence factors driving Klebsiella liver abscess in an ethnically diverse population[J]. Sci Rep, 2016, 6:29316.
[34]	CHOU H C,LEE C Z,MA L C,et al.Isolation of a chromosomal region of Klebsiella pneumoniae associated with allantoin metabolism and liver infection[J]. Infect Immun,2004,72(7):3783-3792.
[35]	YU W L,KO W C,CHENG K C,et al.Comparison of prevalence of virulence factors for Klebsiella pneumoniae liver abscesses between isolates with capsular K1/K2 and non-K1/K2 serotypes[J]. Diagn Microbiol Infect Dis,2008,62(1):1-6.
[36]	WU J H,WU A M,TSAI C G, et al.Contribution of fucose-containing capsules in Klebsiella pneumoniae to bacterial virulence in mice[J]. Exp Biol Med,2008,233(1):64-70.
[37]	NGUYEN Y,SUGIMAN-MARANGOS S,HARVEY H, et al.Pseudomonas aeruginosa minor pilins prime type Ⅳa pilus assembly and promote surface display of the PilY1 adhesin[J]. J Biol Chem, 2015, 290(1):601-611.
[38]	LIN C T, LIN T H,WU C C,et al.CRP-cyclic AMP regulates the expression of type 3 fimbriae via cyclic di-GMP in Klebsiella pneumoniae[J]. PLoS One, 2016, 11(9):e0162884.