艰难梭菌实验室不同检测方法的比较

Comparison of different laboratory detection methods of Clostridium difficile

目的比较不同方法检测艰难梭菌(CD)的临床可行性。方法选取2016年疑似抗菌药物相关腹泻患者大便标本,采用酶联免疫吸附试验(ELISA)和鉴定培养基培养法进行检测,比较两种检测方法的灵敏性、特异性和一致性。结果 ELISA检出抗原阳性标本29例,其中毒素阳性25例,毒素阴性4例;鉴定培养基培养法检出可疑菌株29例,经质谱仪鉴定,其结果为CD28例,1例未检出种属;ELISA和鉴定培养基培养法的灵敏度和特异度分别为97%、100%和93%、95%,两者有极好的一致性(Kappa=0.92)。结论 ELISA具有快速、高效、省时、操作简单、判读容易等特点,可快速准确地筛检CD相关性腹泻病患;培养基培养法特异性好,可以快速得到感染株;二者联合使用可大大提高CD检出率,并对后期治疗有很大帮助。

Objective To compare the clinical feasibility of different methods for detecting Clostridium difficile（CD）.MethodsThe stool samples were collected from the patients with suspected antibiotic-related diarrhea during 2016,and the enzyme linked immunosorbent assay（ELISA）and identification medium culture method were used for detection.Then the sensitivity,specificity and consistency were compared between the two methods.Results 29 cases of antigen-positive specimens were measured by ELISA,including 25 cases of toxin-positive and 4 cases of toxin negative;29 suspected strains were cultured by the selective identification medium,which were identified by the mass spectrometry as 28 strains of Clostridium difficile and 1 strain of undetected species;the sensitivity and specificity of ELISA method and identification culture medium method were 97%,100% and 93%,95% respectively,both methods showed extremely good consistency（Kappa=0.92）.Conclusion The ELISA method has the characteristics of fastness,high efficiency,time saving,simple operation,easy interpretation and so on,and can rapidly and accurately screen CD related diarrhea diseases;the medium culture method has a good specificity and can rapidly obtain the infectious strain;their combined use can greatly increase the CD detection rate and has great help for late treatment.