炎症性肠病住院患者216例的难辨梭状芽孢杆菌感染危险因素和预后

Risk factors and prognosis of Clostridium difficile infection among 216 hospitalized patients with inflammatory bowel disease

目的分析IBD住院患者的难辨梭状芽孢杆菌感染（CDI）的危险因素和预后。方法纳入2014年3月至2015年2月首次住院的216例IBD患者，在人院后立即留取粪便进行难辨梭状芽孢杆菌培养，同时采用PCR法检测难辨梭状芽孢杆菌毒素A和毒素B。分析纳入患者CDI的发生情况和危险因素。统计学分析采用卡方检验或非参数检验。结果216例IBD患者中，UC73例，CD143例。IBD患者的CDI阳性率为13．9％（30／216）。UC患者的CDI阳性率为24．7％（18／73），高于CD患者的8．4％（12／143），差异有统计学意义（X^2=10．690，P〈O．01）。随着疾病严重程度的增加，UC中CDI阳性患者比例增加，3例缓解期、17例轻度活动期、23例中度活动期和30例重度活动期患者中CDI阳性者分别为0、2-511例，差异有统计学意义（X^2=4．820，P=0．028）。UC患者中，CDI阳性和阴性组有入院前3个月内的外院住院史者分别占6／18和7．3％（4／55），差异有统计学意义（X^2=5．740，P=0．020）；两组有入院前30d内的PPI用药史者分别占7／18和7．3％（4／55），差异有统计学意义（X^2=8．270，P=0．004）。CDI阴性的UC患者住院时间为7．0d（5．0d，12．0d），短于CDI阳性患者的10．5d（8．8d，18．2d），差异有统计学意义（U=277．000，P=0．005）。CDI阴性CD患者检测CDI后3个月内肠道切除手术率为10．7％（14／131），低于CDI阳性患者的5／1z，差异有统计学意义（X^2=4．520，P=0．010）。结论国内住院IBD患者有较高的CDI发生率，UC尤为显著，其危险因素包括病情重、入院前3个月内的外院住院史和入院前30d内的PPI用药史，CDI与预后不良有关。

Objective To analyze the risk factors and prognosis of Clostridiurn difficile infection （CDI） among hospitalized patients with inflammatory bowel disease （IBD）. Methods From March 2014 to February 2015, 216 first-time hospitalized patients with IBD were enrolled. Once hospitalized, stool samples were obtained for Clostridium difficile culture immediately, and at the same time toxins of Clostridium difficile （tcd） A and tcdB were detected by polymerase chain reaction（PCR）. The incidence and risk factors of CDI in enrolled patients were analyzed. Chi square test and nonparametric test were performed for statistical analysis. Results Among the 216 IBD patients, there were 73 patients with ulcerative colitis（UC） and 143 patients with Crohnts disease（CD）. The positive rate of CDI was 13.9% （30/216） in IBD patients. The positive rate of CDI was 24.7%（18/73） in UC patients, which was higher than that of CD patients （8.4%, 12/143）, and the difference was statistically sign[ficant （X2 =10. 690, P〈0.01）. As the severity of the disease increased, the rate of CDI positive patients in UC patients increased. Among three patients at remission period, 17 patients at mild active stage, 23 patients at moderate active stage and 30 patients at severe active stage, the CDI positive patients were zero, two, five, 11, respectively, and the difference was statistically significant （X^2 = 4. 820, P=0. 028）. In UC patients, the incidences of patients with hospitalization history in other hospitals within three months before admission in CDI positive group and negative group were 6/18 and 7.3% （4/55）, respectively, and the difference was statistically significant （X^2= 5. 740,P= 0. 020）. In 30 days before admission, the rates of patients with proton pump inhibitor （PPI） taking history of two groups were 7/18 and 7.3 % （4/55 ）, and the difference was statistically significant （X^2 =8. 270 ,P=O. 004）. The length of hospital stay in CDI negative UC patients was 7.0 d （5.0 d, 12. 0 d）, which was shorter than that of CDI positive patients （10.5 d （8.8 d,18.2 d））, and the difference was statistically significant （U=277. 000,P=0. 005）. The rate of patients underwent intestinal operation in CDI negative CD patients within three months after CDI examination was 10.7% （14/131）, which was significantly lower than that of CDI positive patients （5/12） （X^2 =4. 520, P= 0. 010）. Conclusions The incidence of CDI in hospitalized IBD patients was high, especially in UC patients; the risk factors included disease severity, prior hospitalization history within three months before admission and PPI taking history within 30 days before admission. CDI was correlated with poor prognosis.