儿童溃疡性结肠炎合并艰难梭菌感染的危险因素分析

Analysis of risk factors for ulcerative colitis complicated with Clostridium difficile infection in children

目的探讨溃疡性结肠炎(ulcerative colitis,UC)患儿合并艰难梭菌感染(clostridioides difficile infection,CDI)的患病率及临床特点,明确UC合并CDI的危险因素。方法收集2012年1月至2022年11月在郑州大学附属儿童医院消化内科收治的107例确诊UC且完成艰难梭菌检测患儿的临床资料,根据是否发生CDI分为两组,分析两组的临床特点,并进行危险因素分析。结果UC患儿中,男性56例(52.3%),女51例(47.7%),其中24例出现CDI,阳性率22.4%。与非CDI组相比,CDI组中使用抗生素>7 d的比例更高(P=0.001);实验室检查中CDI组中人血清白蛋白低于非CDI组(P=0.015);CDI组中采用激素诱导(>4周)+美沙拉嗪维持治疗、激素诱导(>4周)+免疫抑制剂维持治疗、英夫利西单克隆抗体治疗比例较高(P均<0.05)。多因素分析显示使用抗生素>7 d、激素诱导(>4周)+美沙拉嗪维持治疗、激素诱导(>4周)+免疫抑制维持治疗、英夫利西单克隆抗体治疗是发生CDI的独立危险因素。结论UC患儿治疗过程中使用抗生素超过7 d、美沙拉嗪诱导+维持治疗、免疫抑制剂维持治疗、英夫利昔单抗治疗、临床类型、人血清白蛋白偏低是出现CDI的预测因素。而使用抗生素>7 d、应用免疫抑制剂是独立危险因素,可使得UC患儿发生CDI的风险增加,使儿童UC感染艰难梭菌的概率更大,需警惕或预防治疗。

Objective To investigate the prevalence and clinical features of children with ulcerative colitis(UC)complicated with Clostridioides difficile infection(CDI),and identify the risk factors for UC complicated with CDI.Methods From January 2012 to November 2022,the clinical data of 107 children with UC admitted to the Department of Gastroenterology,Children's Hospital Affiliated to Zhengzhou University,who had completed C.difficile testing were collected and divided into two groups according to the occurrence of CDI.Clinical characteristics of the two groups were analyzed,and risk factors were analyzed.Results There were 56 males(52.3%)and 51 females(47.7%)with UC,24 of whom showed CDI,with a positive rate of 22.4%.Compared with the non-CDI group,the proportion of antibiotics>7 days(d)in the CDI group was significantly higher(P=0.001).The serum albumin in CDI group was significantly lower than that in non-CDI group(P=0.015).In CDI group,the proportion of hormone induction(>4 weeks)+mesalazine maintenance therapy,hormone induction(>4 weeks)+immunosuppressive maintenance therapy and infliximab clonal antibody therapy were higher(all P<0.05).Multivariate analysis showed that antibiotic use>7 days,hormone-induced(>4 weeks)+mesalazine maintenance therapy,hormone-induced(>4 weeks)+immunosuppressive maintenance therapy,and infliximab clonal antibody therapy were independent risk factors for CDI.Conclusion Antibiotic use for more than 7 days,mesalazine induction and maintenance therapy,immunosuppressive maintena-nce therapy,infliximab therapy,clinical type and low serum albumin are predictors of CDI in children with UC.Antibiotic use>7 days,and immunosuppressant use are independent risk factors,which can increase the risk of CDI in children with UC and increase the probability of Clostridium difficile infection in children with UC,requiring vigilance or preventive treatment.