暴发性艰难梭菌结肠炎：危重症领域的新挑战

Fulminant Clostridium difficile colitis： new challenges in critical care medicine

暴发性艰难梭菌结肠炎（FCDC）是由艰难梭菌（CD）引起的，表现为严重腹泻、发热、腹胀、电解质紊乱、低蛋白血症，同时可引起伪膜性肠炎、中毒性巨结肠、结肠穿孔、感染性休克、多器官功能障碍等全身中毒症状严重的结肠炎。CD已经成为最主要的医疗机构相关感染病原体之一，尤其近期发现的CD新型突变株NAP1/BI/ribotype 027具有导致全球流行和暴发的高致病性。近年来全球FCDC的发病率和致死率有明显上升趋势，而广谱抗菌药物的使用是FCDC发病的基本风险因素，因此，FCDC给目前临床工作提出了新的挑战。现就FCDC的相关流行病学、风险因素、发病机制、诊断方法、严重程度分级、临床治疗新进展进行综述，以期为FCDC的临床治疗和相关研究提供帮助。

Fulminant Clostridium difficile colitis （FCDC） means severe Clostridium difficile colitis （CDC）, which often manifested with severe diarrhea, fever, abdominal distention, electrolyte disorder, hypoalbuminemia, and it can lead to pseudo membrane colonitis, toxic megacolon, bowel perforation, septic shock, and multiple organ dysfunction. Now Clostridium difficile （CD） becomes one of the most important medical institutions related infectious pathogens. In particular, the recently discovered mutant CD strain NAP1/BI/ribotype 027 has high pathogenicity in the global epidemic and its outbreak. The morbidity and mortality of FCDC has a significant upward trend in the global in recent years. All broad spectrum antimicrobials usage is considered to be the primary risk factor for the onset of FCDC. Therefore, FCDC has become a new challenge for clinical work. The epidemiology, related risk factors, pathogenesis, diagnosis, severity classification, recent progress in clinical treatment of FCDC were reviewed in order to provide help for clinical treatment of FCDC and related research.