四例肝硬化合并艰难梭菌感染者的诊治及文献复习

Diagnosis and treatment of four liver cirrhosis cases complicated with Clostridium difficile infection and literature review

目的探讨肝硬化晚期合并难辨梭菌感染的临床特点和预后。方法回顾性分析于首都医科大学附属北京地坛医院2018年1月年至2019年5月单中心诊断的4例肝硬化合并难辨梭菌感染者的诊疗过程及随访,并结合文献复习。结果4例患者均为失代偿期肝硬化且合并多种并发症,难辨梭菌感染为首发,通过粪便检测难辨梭菌葡糖脱氢酶(GDH)联合毒素酶联免疫法检测确诊,其中3例为暴发型,1例为复发;4例患者均给予万古霉素治疗;2例存活,2例于发病后1年内死亡且其中1例于确诊24 h内死亡。结论提高临床认知、尽早完善确诊实验室检查并及时确诊治疗是控制肝硬化合并难辨梭菌感染的关键。

Objective To investigate the characteristics and prognosis of Clostridium difficile infection in patients with advance liver cirrhosis.Methods From January 2018 to May 2019,four cases were diagnosed with Clostridium difficile infection and liver cirrhosis in Beijing Ditan Hospital,Capital Medical University.The diagnosis,treatment and clinical outcome of the four cases were analyzed,respectively and relevant literature were reviewed.Results All cases with initial episode with Clostridium difficile infection were advanced liver cirrhosis patients with various complications.A definite diagnosis was performed by fecal detection of Clostridium difficile gluconate dehydrogenase(GDH)combined with toxin enzyme-linked immunosorbent assay.There were 3 cases with fulminant type and 1 case recurred.All 4 cases were treated with vancomycin.Two cases died within one year after onset,among whom one case died within 24 h.Conclusions Improving clinical cognition,perfect diagnosis test,timely diagnosis and treatment of Clostridium difficile in patients with liver cirrhosis was essential to reduce the incidence and morbidity.