艰难梭菌毒素蛋白表达与艰难梭菌感染分级关系的研究

Expression of Clostridium difficile toxin protein and its relationship with classification of Clostridium difficile infection

目的分析医院艰难梭菌感染(clostridiumdifficile infection,CDI)患者的临床表现与实验室检查结果,初步研究艰难梭菌毒素蛋白表达与CDI严重程度分级的关系。方法收集2016年3月-2017年5月医院连续采集的860例腹泻便样本,采用Techlab Cdiff Quik Check Complete试剂盒和艰难梭菌毒素基因试剂盒分别检测艰难梭菌谷氨酸脱氢酶抗原(Clostridium difficile glutamate dehydrogenase antigen,GDH)、艰难梭菌毒素蛋白和艰难梭菌毒素基因,并对CDI患者临床资料和实验室结果进行统计分析。结果 860份腹泻样本中,GDH阳性99例占11.51%,其中艰难梭菌毒素蛋白阳性16例占16.16%,毒素基因阳性94例占94.95%;艰难梭菌毒素蛋白阳性患者的外周血白细胞数量、血清肌酐水平、腹泻次数、CDI分级指数及院内CDI患者概率均高于毒素蛋白阴性患者(P<0.05)。结论艰难梭菌毒素蛋白阳性患者常伴随严重的艰难梭菌感染临床表现,推测艰难梭菌毒素蛋白可作为一项重度艰难梭菌感染的预测指标,为临床判断CDI分级及合理选择治疗方案提供及时客观的依据。

OBJECTIVE In this study,we retrospectively analyzed the clinical manifestations and laboratory results of Clostridium difficile infection in Hangzhou First Hospital and studied the relationship between Clostridium difficile(CD)toxin protein expression and CDI severity grading.METHODS We collected a total of 860 stool samples in the hospital from Mar.2016 to May 2017,tested CD glutamate dehydrogenase antigen(GDH),CD toxin protein and CD toxin gene using Techlab Cdiff Quik Check Complete kit and CD toxin gene kit,and statistically analyzed the clinical data and laboratory results of CDI patients.RESULTS Among the 860 diarrhea samples,99 cases were positive in GDH(11.51%,99/860),among which 94 cases were positive in CD toxin gene(94.95%,94/99)and 16 cases were positive in CD toxin protein(16.16%,16/99).The clinical data analysis of CDI patients showed that the number of white blood cells in peripheral blood,serum creatinine level,number of diarrhea,the proportion of hospital-acquired CDI and CDI grading index of patients with positive toxin protein were significantly higher than those with negative toxin protein(P<0.05).CONCLUSION CD toxin protein-positive patients were often accompanied by severe clinical manifestations of CDI,which suggested that CD toxin protein can be used as a predictor of severe CDI.In conclusion,CD toxin protein can provide a timely and objective basis for the clinical judgment of CDI classification and treatment.