艰难梭菌在公民逝世后器官捐献供肾移植患者中发病特点的分析

Analysis of the Pathogenic Characteristics of Clostridium Difficile in Recipients of Deceased Donor Kidney Transplantation

目的观察艰难梭菌(clostridium difficile,CD)在公民逝世后器官捐献(deceased donation,DD)供肾移植患者中的发病特点。方法回顾性分析昆明市第一人民医院甘美医院泌尿外科收治的87例异体肾移植患者的资料,根据有无腹泻症状及有无肠道艰难梭菌感染(clostridium difficile infection,CDI),将其分为慢性腹泻并感染组(A组)20例;慢性腹泻但CDI阴性(B组)21例;无腹泻症状携带CD组(C组)16例;无腹泻及CDI组(D组)30例,观察四组患者CDI发生率、发生时间及与他克莫司(tacrolimus,FK-506)谷浓度关系。结果A组和C组术后出现CDI的时间分别为(25.84±45.30)个月,(8.02±14.59)个月,组间比较,差异无统计学意义(t=1.3229,P>0.05);CDI在DD肾移植后的发生率为41.38%(36/87),在慢性腹泻患者中的发生率为48.78%(20/41);FK-506的谷浓度与是否发生CDI无相关性(回归方程:Y=5.1601+0.2400X,P>0.05)。结论DD供肾异体移植患者术后肠道CDI发生的时间无明显规律,与术后口服FK-506的时间、谷浓度无相关性;该类患者慢性腹泻原因较复杂,肠道CD感染值得关注。

Objective To observe the characteristics of clostridium difficile(CD)in patients with deceased donor(DD)renal transplantation.Methods The data for 87 patients receiving allogeneic renal transplantation were analyzed retrospectively,according to the presence of diarrhea symptoms and intestinal CD infection(CDI).The patients were divided into a chronic diarrhea and infection group(group A,n=20).We identified 21 patients with chronic diarrhea who were CDI(-)(group B,n=21),16 patients with asymptomatic CD(group C,n=16)and 30 patients without diarrhea and CDI(group D,n=30).The incidence,time(month)of CDI and its relationship with the valley concentration of tacrolimus(FK-506)were observed.Results The time of postoperative CDI in group A and group C was(25.84±45.30)months and(8.02±14.59)months,respectively.No significant difference was observed between groups(t=1.3229,P>0.05).The incidence of CDI after DD renal transplantation was41.38%(36/87),and the incidence of chronic diarrhea was 48.78%(20/41).No correlation was observed between the valley concentration of FK-506 and CDI(regression equation:Y=5.1601+0.2400 X,P>0.05).Conclusion The time of intestinal CDI occurrence in patients with DD renal allografts did not show a clear trend,and was not correlated with the time and valley concentration of postoperative oral FK-506.The causes of chronic diarrhea in these patients are complex,and intestinal CDI warrants further attention.