住院患者艰难梭菌定植和感染特征分析

Characteristic analysis of Clostridium difficile colonization and infection in inpatients

目的分析艰难梭菌在住院患者肠道不同状态下的毒力特征,为艰难梭菌感染性腹泻(CDI)的防治提供参考。方法收集2019年2—6月首都医科大学附属北京友谊医院住院患者粪便样本432例,根据有无腹泻症状将所有患者分为腹泻组(198例)和无腹泻组(234例)。培养并分离艰难梭菌后,进行艰难梭菌毒素基因和毒素蛋白表达量检测、细胞毒性试验。比较2个组各项检测结果的差异。结果腹泻组和无腹泻组毒素基因阳性率差异无统计学意义(P>0.05)。腹泻组毒素蛋白表达量显著高于无腹泻组(P<0.05);细胞毒性试验结果显示,2个组细胞均发生了病变效应,腹泻组细胞死亡数明显多于无腹泻组(P<0.05)。结论产毒型与非产毒型艰难梭菌均可在住院患者体内定植而不引起腹泻;艰难梭菌产毒素量与毒性强弱是导致患者是否出现腹泻症状的重要因素。

Objective To analyze the toxicity characteristics of Clostridium difficile in different intestine states of inpatients,and to provide a reference for the prevention and treatment of Clostridium difficile infection(CDI).Methods The 432 fecal samples of inpatients were collected from Beijing Friend Hospital of Capital Medical University from February to June 2019.All the patients were classified into diarrhea group(198 cases)and diarrheafree group(234 cases)based on whether they had diarrhea symptoms.The isolates of Clostridium difficile were isolated from the fecal samples.The isolates were determined for toxin gene,toxin protein expression and cytotoxicity test.The results of 2 groups were analyzed statistically.Results There was no statistical significance in the positive rate of toxin gene between the 2 groups(P>0.05).The toxin protein expression of diarrhea group was higher than that of diarrhea-free group(P<0.05).The results of cytotoxicity test showed that the 2 groups had lesions,but the number of cell death in diarrhea group was higher than that in diarrhea-free group(P<0.05).Conclusions Both toxic and non-toxic Clostridium difficile can colonize without diarrhea in inpatients.The increase in toxin production and toxicity of Clostridium difficile are factors in the clinical presence of diarrhea symptoms.