肠道艰难梭菌定植对老年住院患者肝生化指标的影响

Effects of colonization of Clostridium difficile on hepatic biochemical indexes in elderly hospitalized patients

目的通过检测老年住院患者粪便标本中的艰难梭菌,分析定植者与非定植者实验室指标的差异,进而探索艰难梭菌定植对老年住院患者的影响。方法收集2019年4月—10月医院收治的60岁以上老年住院患者粪便标本进行厌氧培养,对培养阳性的35株菌株用免疫学方法检测谷氨酸脱氢酶和毒素,收集患者临床资料,分析肠道艰难梭菌定植对老年住院患者肝生化指标的影响。结果187例老年住院患者检出艰难梭菌35株,阳性率为18.72%,产毒素菌株占82.86%(29/35)。老年住院患者艰难梭菌定植率随年龄增大而升高,且定植患者血清白蛋白、前白蛋白、丙氨酸氨基转移酶、天冬氨酸氨基转移酶、总胆红素、直接胆红素、总胆汁酸等肝生化指标异常比例较非定植患者高(P<0.05)。结论老年住院患者是艰难梭菌定植易感人群,艰难梭菌定植可能对老年患者肝肾功能造成影响,且加大艰难梭菌感染风险,加重临床治疗负担,提示应加强对年龄大、免疫功能低下且有基础疾病的老年入院患者艰难梭菌定植的筛查和监测。

Objective To explore the impact of Clostridium difficile colonization on elderly hospitalized patients by analyzing the differences in laboratory indicators between Clostridium difficile colonized patients and non-colonized patients and detecting Clostridium difficile in fecal specimens of elderly hospitalized patients.Methods The fecal specimens of elderly inpatients over 60 years old from April to October 2019 in the hospital were collected for Clostridium difficile anaerobic culture,and the immunologic tests were carried out in 35 strains of positive cultures for glutamate dehydrogenase and toxins.The clinical data of patients were collected,and the influence of colonization of intestinal Clostridium difficile on hepatic biochemical indexes of the elderly was analyzed.Results 35 strains of Clostridium difficile were detected in 187 elderly hospitalized patients,the positive rate was 18.72%,and toxin-producing strains accounted for 82.86%(29/35).The colonization rate of Clostridium difficile in elderly hospitalized patients increases with age,and the proportion of abnormal hepatic biochemical indexes such as serum albumin,prealbumin,alanine aminotransferase,aspartate aminotransferase,total bilirubin,direct bilirubin,total bile acid in colonized patients was higher than that in non-colonized patients(P<0.05).Conclusion Elderly hospitalized patients are susceptible to Clostridium difficile colonization.Clostridium difficile colonization may affect the liver and kidney function of elderly patients and increase the risk of Clostridium difficile infection,which increase the burden of treatment.It is recommended to strengthen the surveillance and screening of Clostridium difficile colonization in elderly hospitalized patients with low immune function and underlying disease.