炎症性肠病患者艰难梭菌感染的流行情况及危险因素研究

Prevalence and risk factors of Clostridium difficile infection in patients with inflammatory bowel disease

目的研究炎症性肠病(IBD)患者艰难梭菌感染的流行情况及危险因素,为临床治疗提供依据。方法将2017年11月至2019年6月于广州中山大学附属第一医院入院的130例炎症性肠病患者纳入研究。根据患者IBD诊断,将患者分为克罗恩病组(CD)和溃疡性结肠炎组(UC),收集其入院48 h内粪便标本。采用免疫荧光法检测谷氨酸脱氢酶(GDH)、艰难梭菌A/B毒素(CDAB),实时荧光PCR法检测粪便艰难梭菌毒素B基因(tcdB),显色培养法检测艰难梭菌,根据艰难梭菌检测结果与患者临床情况,将患者分为阴性组、定植组和感染组,比较CD和UC两组间各项指标差异和四种检测方法的检测结果。结果在130例炎症性肠病患者中,克罗恩病组(CD)和溃疡性结肠炎组(UC)例数分别为80(61.5%)和50(38.5%);CD组艰难梭菌定植率和感染率分别为20.0%(16/80)和8.8(7/80)%;溃疡性结肠炎定植率和感染率分别为16.0%(8/50)和26.0%(13/50);两组间一般情况、大便检测情况与炎症标志物中多项指标比较,差异有统计学意义(P<0.05)。显色培养法、免疫荧光法检测GDH、CDAB、PCR法检测tcdB的阳性率分别为29.2%、29.2%、3.1%和20.8%。粪便艰难梭菌毒素B基因一步法检测艰难梭菌感染与指南推荐联合法结果比较,差异无统计学意义(P>0.05)。结论 UC患者比CD患者更容易感染艰难梭菌;需要重视IBD患者的艰难梭菌定植情况。

Objectives To study the prevalence and risk factors of Clostridium difficile infection in patients with inflammatory bowel disease(IBD) to provide a basis for clinical treatment.Method 130 patients with inflammatory bowel disease admitted to the First Affiliated Hospital of Sun Yat-sen University in Guangzhou from November 2017 to June 2019 were included in the study.According to the diagnosis of IBD,the patients were divided into Crohn’s disease group(CD) and ulcerative colitis group(UC),and stool samples were collected within 48 hours of admission.which The Chromogenic culture,toxin A/B enzyme immunoassay(CD AB),glutamate dehydrogenase enzyme immunoassay(GDH) and real-time fluorescent quantitative PCR detection of gene for toxin B(tcdB) were used to detect Clostridium difficile.According to the test results of Clostridium difficile and the clinical conditions of the patients,the patients were divided into negative group,colonization group and infection group,and the differences in various indicators between the CD and UC groups and the test results of the four detection methods were compared.Result Among 130 patients with IBD,the numbers of Crohn’s disease group(CD) and ulcerative colitis group(UC) were 80(61.5%) and 50(38.5%),respectively.The colonization rate and infection rate of Clostridium difficile in the CD group were20.0%(16/80) and 8.8(7/80) %,respectively.The colonization rate and infection rate in ulcerative colitis were 16.0%(8/50) and 26.0%(13/50) respectively.There were significant differences between the two groups in general conditions,stool detection conditions and multiple indicators of inflammation markers(P<0.05).The positive rates of chromogenic culture method,immunofluorescence method to detect GDH,CDAB,and qRT-PCR method to detect tcdB were 29.2%,29.2%,3.1% and 20.8%,respectively.There was no statistically significant difference between the results of one-step detection of Clostridium difficile toxin B gene in fecal C.difficile infection and the combined method recommended by the guidelines(P>0.05).Concl-?sions UC patients are more likely to be infected with C.difficile than CD patients.Attention should be paid to the colonization of C.difficile in patients with IBD.