急性骨髄性白血病寛解導入中に発症したtoxic shock syndromeの1例:急性期炎症性サイトカイン値の変動

フォーマット:

論文

責任表示:

丹生, 龍太郎 ; 谷内江, 昭宏 ; 榊原, 方枝 ; 太田, 和秀 ; 関, 秀俊 ; 宮脇, 利男 ; 谷口, 昂

言語:

日本語

出版情報:

日本臨床免疫学会 = The Japan Society for Clinical Immunology, 1993-01-01

著者名:

丹生, 龍太郎

谷内江, 昭宏

榊原, 方枝

太田, 和秀

関, 秀俊

宮脇, 利男

谷口, 昂

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掲載情報:

日本臨床免疫学会会誌 = Japanese Journal of Clinical Immunology

ISSN:

0911-4300      

巻:

16

通号:

5

開始ページ:

376

終了ページ:

382

バージョン:

publisher

概要:

Toxic shock syndrome(TSS)は,ブドウ球菌外毒素産生が誘因となり発症,高熱や多臓器障害を特徴とする重篤な疾患である.ブドウ球菌外毒素はスーパー抗原としてT細胞に作用,活性化,さらに種々のサイトカイン産生を誘導,これらのサイトカインがTSSの病態形成に重要な役割を果たすことが示唆されている.われわれは白血病の寛解導入中にTSSを発症した1例を経験し,炎症性サイトカインの動態について検討した.患児は化学療法導入後間もなくから,発熱,意識障害,肝腎機能低下,循 … 環不全,全身紅斑を認め,回復期に特徴的な皮膚剥脱が観察された.急性期に炎症性サイトカインであるTNF-α, IL-1β, IL-6の高値に加え, IFN-γの著増が認められ,これらの値は症状の改善とともに急速に正常化した. TSSの発症には炎症性サイトカイン,特にIFN-γをはじめとするT細胞由来サイトカインの過剰産生が重要な役割を果たしていることが示された. Toxic shock syndrome (TSS) is an acute, multisystem illness characterized by high fever, circulatory failure, desquamative skin lesion and multiple organ damage. It is usually associated with a focus of infection with staphylococcus aureus and its exotoxins have been considered to be the major contributing agents in the pathogenesis of TSS. Recently, it has become clear that most of the staphylococcal exotoxins acts as superantigens, activating a large fraction of T cells at the same time. The production of various cytokines induced by these toxins have been implicated in the development of TSS. We recently experienced a case of TSS in a 15-year-old boy. The characteristic features of the illness developed shortly after the introduction of anti-leukemic chemotherapy for acute myelocytic leukemia. Rapid deterioration of the clinical conditions was associated with high fever, circulatory failure, and evidence of liver damage. Oliguria and increase of BUN were also evident. Generalized erythematous skin lesion appeared at the peak of the illness. The patient's clinical condition recovered after short period of supportive therapy and the characteristic desquamation appeared during the convalescence. Staphylococcus aureus was recovered from the swollen lymph node in the neck. Antibody titers against TSST-1 and SEB remained high during the illness and did not show any appreciable change. There was no expansion or deletion of T cells with a particular Vβ repertoire during the course of illness. Although no specific toxin was found to be responsible, the characteristic clinical pictures were diagnostic of TSS. Patient's altered defense and the chemotherapy might have changed the growth and toxin producing profiles of the preexisting bacteria. Serum cytokine levels were measured during the acute stage of the illness. Not only monokine like IL-1β, TNFα and IL-6, but also IFNγ levels were markedly elevated during the acute stage of the illness. These cytokine levels returned quickly to normal values within a few days. The data indicated that the excessive production of the T cell derived cytokines, such as IL-2 and IFN-γ, play major roles in the development of the characteristic clinical picture of TSS. 続きを見る

URL:

http://hdl.handle.net/2297/35867