人艰难梭菌感染的致病机制与防治策略研究进展

Progress in the Pathogenic Mechanisms and Treatments of Human Clostridium Difficile Infection

艰难梭菌是一种非常重要的医院感染病原菌,其感染占抗菌素相关腹泻的10-25%,占抗菌素相关肠炎的50-75%,占抗菌素相关伪膜炎的90-100%。而且越来越多的证据表明艰难梭菌的感染与其它疾病,如活性关节炎、婴儿突发性死亡、溶血性尿毒症、坏死性肠炎、希施斯普龙病等有关。更糟糕的是艰难梭菌存在着复发性感染,15-20%的病人在成功治愈后会复发。近年来,随着强毒株的出现,艰难梭菌的感染率和发病率逐年上升,病情也越来越严重,由艰难梭菌感染引起的死亡率也成倍增加。到目前为止,艰难梭菌发病率升高的原因及其致病机制还有待进一步研究。由于艰难梭菌是一种孢子产生菌,对大部分抗菌素都有抗性,目前用于艰难梭菌防治的主要抗菌素甲硝唑和万古霉素的治疗效果也在不断下降,所以正确认识艰难梭菌的感染与流行,进一步了解其致病机制,寻找新的替代疗法已是迫在眉睫。本文对艰难梭菌感染和流行的病因进行了较为全面的分析,对其致病机制进行了深入的总结,并探讨了艰难梭菌防治的最新策略和方法,将有利于更好的认识和研究艰难梭菌,为艰难梭菌的防治提供新思路。

Clostn＇dium difficile is an important nosocomial pathogen. Its infection is responsible for 10-25% of cases of antibiotic associated diarrhea, 50-75% of cases of antibiotic associated enteritis and 90-100% of cases of pseudomembranous colitis. There is also increasing evidence for a potential pathogenic role in other diseases including reactive arthritis, the sudden infant death syndrome, haemolytic uraemic syndrome, necrotising enterocolitis and Hirschsprung＇s disease. More terrible is that C. diflicile infection is a relapsable disease. A substantial proportion of patients （15 to 20 percent） has a relapse of diarrhea fTom C. ＆＇fticile infection when the initial therapy is discontinued. Recently, along with the present of high virulent strains, the infection rates and incidence of C. dJflicile is increasing. And the state after infection is more serious with multiplied death rates. So far, the reasons cause the popular of C. ditticile and its pathogenic mechanisms still need further study. Moreover, C. difBcile can generate spores, and have the ability to resistant most of the antibiotics. The treatment effects of normally used antibiotics metronidazole and vancomycin are decreasing. Knowing the infection and popular of C. difticile, understanding it＇s pathogenic mechanisms, and looking for other treatment methods have become extremely urgent. In this paper, we analyzed the reasons why C. ditticile infection and prevalence, summarized the pathogenic mechanisms of C. difticile and discussed the new strategies and methods for controlling and treatment of C. ditiicile related diseases. It will be better for well understand and studying C. difficile related diseases, and providing new thoughts for C. difticile controlling and treatment.