难治性炎症性肠病患者艰难梭状芽胞杆菌感染流行病学及临床特征

Epidemiological and clinical characteristics of Clostridium difficile infection in patients with refractory inflammatory bowel disease

目的探讨难治性炎症性肠病患者艰难梭状芽胞杆菌感染的流行病学及临床特征,为临床防治艰难梭状杆菌感染提供依据。方法选取2013年1月-2016年1月医院收治的难治性炎症性肠病患者92例,采用荧光酶免疫法检测其粪便中艰难梭状芽胞杆菌感染情况,分析艰难梭状芽胞杆菌感染的难治性炎症性肠病患者的临床特征。结果 19例难治性炎症性肠病患者感染艰难梭状芽胞杆菌,感染率为20.65%,其中溃疡性结肠炎患者感染率为20.83%,克罗恩病患者感染率为20.45%;使用抗菌药物、万古霉素和处于活动期的难治性炎症性肠病患者艰难梭状芽胞杆菌感染率显著增高(P<0.05);溃疡性结肠炎患者病情严重度为重度、中度和轻度的患者艰难梭状芽胞杆菌感染率分别为44.44%、5.56%和8.33%,差异有统计学意义(P<0.05);结肠受累患者艰难梭状芽胞杆菌感染率显著升高(P<0.05);克罗恩病结肠部位受累患者艰难梭状芽胞杆菌感染率显著升高(P<0.05)。结论难治性炎症性肠病患者艰难梭状芽胞杆菌感染率较高,与抗菌药物、万古霉素、病情活动度、病情严重度和结肠受累有关。

OBJECTIVE To explore the epidemiological and clinical characteristics of Clostridium difficile infections in patients with refractory inflammatory bowel disease so as to provide guidance for clinical prevention and treatment of the C.difficile infections.METHODS A total of 92 patients with refractory inflammatory bowel disease who were treated in hospitals from Jan 2013 to Jan 2016 were enrolled in the study,the prevalence of C.difficile infections in stools was detected by using fluorescent enzyme immunoassay,and the clinical characteristics of the refractory inflammatory bowel disease patients with C.difficile infections were observed.RESULTS The incidence rate of C.difficile infections was 20.5% in the patients with refractory inflammatory bowel disease,20.83 % in the patients with ulcerative colitis,20.45 % in the patients with Crohn disease.The incidence rate of C.difficile infections was significantly increased in the patients with refractory inflammatory bowel disease who used antibiotics,vancomycin,or were in active stage （P〈0.05）.The incidence rate of C.difficile infections was 44.44% in the patients with severe ulcerative colitis,5.56% in the patients with moderate ulcerative colitis,8.33% in the patients with mild ulcerative colitis,and there was significant difference （P〈0.05）.The incidence rate of C.difficile infection was significantly increased in the patients with colon involved （P〈0.05）;the incidence rate of C.difficile infections was significantly increased in the Crohn disease patients with colon involved （P〈0.05）.CONCLUSION The incidence rate of C.difficile infections is relatively high in the patients with refractory inflammatory bowel disease,which is associated with the use of antibiotics,vancomycin,range of motion,severity of disease,and colon involvement.