非伤寒沙门菌耐药和毒力机制的研究 进展
Research Progress on the Drug Resistance and Virulence Mechanisms of Nontyphoidal Salmonella
DOI: 10.12677/acm.2026.1652066, PDF,   
作者: 杜歆闻：吉首大学医学院，湖南 吉首；杨桂花：张家界市人民医院小儿感染科，湖南 张家界
关键词: 非伤寒沙门菌；侵袭性非伤寒沙门菌病；ST313；耐药；毒力；致病岛；生物膜；Non-Typhoidal Salmonella； Invasive Non-Typhoidal Salmonella Disease； ST313； Drug Resistance； Virulence； Pathogenicity Island； Biofilm
摘要: 非伤寒沙门菌(NTS)是由多个血清型与流行克隆共同构成的疾病谱。多数NTS感染表现为自限性胃肠炎，但在婴幼儿、老年人、HIV感染者、近期疟疾患者、营养不良者及免疫功能低下人群中，易发展为侵袭性非伤寒沙门菌病(iNTS)，引发菌血症、脓毒症及肠外感染，临床常以发热为主要表现，胃肠道症状不突出。全球iNTS疾病负担以撒哈拉以南非洲地区最重，高危人群病死风险高。目前NTS耐药谱持续扩大，对喹诺酮/氟喹诺酮、第三代头孢菌素、多黏菌素及碳青霉烯类药物的耐药性已在多地检出。NTS的致病能力并非由单一毒力基因决定，而是由致病岛、III型分泌系统、黏附因子、毒力质粒、生物膜、胞内适应与免疫逃逸等多层机制共同调控。以非洲鼠伤寒沙门菌ST313为代表的高风险侵袭性克隆表明，高侵袭性与高耐药性并非独立演化，而是在克隆背景、移动遗传元件与调控网络共同作用下协同形成。本文在系统梳理NTS耐药与毒力机制的基础上，将ST313及非洲侵袭性S. Enteritidis克隆作为重点案例，讨论这些机制“是什么、为什么重要、还存在哪些不确定性”，并提出若干值得优先回答的关键科学问题。
Abstract: Non-typhoidal Salmonella (NTS) constitutes a disease spectrum composed of multiple serotypes and epidemic clones. The majority of NTS infections present as self-limiting gastroenteritis, but in infants and young children, the elderly, HIV-infected individuals, recent malaria patients, malnourished individuals, and those with compromised immune systems, it can develop into invasive non-typhoidal Salmonella disease (iNTS), causing bacteremia, sepsis, and extraintestinal infections. Clinically, fever is the main manifestation, while gastrointestinal symptoms are not prominent. The global burden of iNTS is most severe in sub-Saharan Africa, with high mortality risks among high-risk populations. Currently, the drug resistance spectrum of NTS continues to expand, and resistance to quinolones/fluoroquinolones, third-generation cephalosporins, polymyxins, and carbapenems has been detected in many regions. The pathogenicity of NTS is not determined by a single virulence gene but is regulated by multiple mechanisms, including pathogenic islands, type III secretion systems, adhesion factors, virulence plasmids, biofilms, intracellular adaptation, and immune evasion. High-risk invasive clones represented by Salmonella Typhimurium ST313 in Africa indicate that high invasiveness and high drug resistance are not independently evolved but are formed in a coordinated manner under the combined influence of the clonal background, mobile genetic elements, and regulatory networks. Based on a systematic review of the drug resistance and virulence mechanisms of NTS, this article focuses on ST313 and invasive Salmonella Enteritidis clones in Africa as key cases to discuss “what they are, why they are important, and what uncertainties remain”, and proposes several key scientific questions that deserve priority answers.
文章引用：杜歆闻, 杨桂花. 非伤寒沙门菌耐药和毒力机制的研究 进展[J]. 临床医学进展, 2026, 16(5): 2553-2564. https://doi.org/10.12677/acm.2026.1652066

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