异基因造血干细胞移植过程中患者艰难梭菌感染与肠道微生态失调关系的临床研究

本研究探讨异基因造血干细胞移植（allogeneic hematopoietic stem cell transplantation,allo-HSCT）过程中患者艰难梭菌相关性腹泻（clostridium difficile associated diarrhea,CDAD）与肠道微生态的关系,了解肠道微生态失衡的临床特征,寻找有效防治措施,保护肠道菌群,减少细菌易位及感染的发生。对44例allo-HSCT后腹泻患者采用艰难梭菌毒素A＆B检测试剂盒进行毒素检测,采用厌氧培养方法进行艰难梭菌的分离、鉴定。对患者粪便标本进行肠道微生态研究;采用光冈复合式法对目的菌群（双歧杆菌、乳酸杆菌、类杆菌、消化链球菌、产气荚膜梭菌、肠杆菌、肠球菌、酵母菌）进行定性定量分析。结果表明：44例腹泻患者中共检测出12例艰难梭菌阳性,阳性率为27.27%;CDAD的发生与使用抗生素或化疗药物有关;CDAD患者的肠道微生态发生了明显变化,表现为乳酸杆菌、双歧杆菌、类杆菌、肠杆菌等细菌数量明显下降;对CDAD用万古霉素、甲硝唑等药物并配合给予益生菌治疗效果好,但有一定复发率（16.67%）。结论：allo-HSCT并发CDAD与肠道微生态的改变有关,应用敏感抗生素治疗的同时应积极扶植肠道菌群,这样的治疗有利于改善病情和减少复发。

Relationship Between Clostridium Difficile Associated Diarrhea and Intestinal Microecosystem Disorder in Patients Received Allogeneic Hematopoietic Stem Cell Transplantation

This study was to investigate the relationship between Clostridium difficile associated diarrhea (CDAD) and intestinal microecosystem in patients received allogeneic hematopoietic stem cell transplantation (allo-HSCT) and to clarify clinical characteristics of intestinal microecosystem disorder. Clostridium difficile (CD) was isolated and identified by enzyme-linked-immunosorbent assay using clostridium difficile Premier toxins A&B Kit and anaerobic culture in 44 cases with diarrhea. Fecal flora (bifidobacteria, lactobacillus, bacteroides, peptostreptococcus, Clostridium perfringens, enterobacteriaceae, enterococcus, and yeasts) of patients were quantitatively and qualitatively analyzed by Mitsuoka's methods. The results showed that CDAD occurred after using antibiotic or chemotherapy. Clostridium difficile was detected in 12 patients with diarrhea (positive rate was 27.27%). There was marked changes of intestinal microecosystem when patients suffered from CDAD. The number of lactobacillus, bifidobacteria, bacteroides, enterobacteriaceae and so on decreased significantly. It was effective to treat CDAD with vancomycin, metronidazole and probiotic, but the recurrence rate was 16.67%. In conclusion, CDAD complicated by allo-HSCT is related to change of intestinal microecosystem. While treating CDAD with the sensitive antibiotic, the intestinal flora of patients should be supported actively. This treatment contributes to improving disease status and reducing diarrhea recurrence.