安徽地区临床腹泻患者艰难梭菌感染的临床特征及独立危险因素分析

目的 探讨安徽地区艰难梭菌感染(Clostridium difficile infection, CDI)的临床特征及独立危险因素。方法 收集2017年10月～2019年10月安徽医科大学第二附属医院877例临床腹泻患者粪便标本1 059例,测定艰难梭菌谷氨酸脱氢酶(glutamate dehydrogenase,GDH)抗原及毒素。记录CDI患者临床资料,选取同期非CDI腹泻患者90例为对照组,应用单因素及多因素Logistic回归确定CDI发生的独立危险因素。结果 在877例患者中共检出艰难梭菌GDH抗原205例,阳性率为23.4%(205/877)。其中46例毒素检测阳性,CDI发生率为5.2%(46/877)。与对照组比较,CDI组年龄(69.3±14.1岁 vs 59.5±16.6岁)明显升高,差异有统计学意义(t=3.403, P<0.05),且肺部感染、住院时间及30天内使用广谱抗生素因素上差异有统计学意义(χ²=10.120,10.477,21.080,均P<0.05),而血红蛋白(102.1±29.8 g/L vs 113.3±25.7 g/L)及血清清蛋白(30.3±6.4 g/L vs 34.7±6.8 g/L)水平明显降低,差异有统计学意义(t=-2.285,-3.520,均P<0.05)。高龄和30天内使用广谱抗生素(OR=1.042,29.274,均P<0.05)是CDI发生的独立危险因素。结论 对住院腹泻患者进行艰难梭菌GDH抗原及毒素测定有重要的临床价值,尤其对高龄和使用广谱抗生素的腹泻患者警惕CDI发生。

Analysis of Clinical Characteristics and Independentrisk Factors for Clostridium Difficile Infection of Patients with Clinical Diarrhea in Anhui Area

Objective To analyze the clinical features and independent risk factors of Clostridium difficile infection(CDI). Methods A retrospective analysis was conducted of 877 hospitalized diarrhea patients in the Second Affiliated Hospital of Anhui Medical University from October 2017 to October 2019. 1 059 stool specimens were collected, while the GDH antigen and toxin of Clostridium difficile were detected. The clinical data were recorded and the univariate and multivariate Logistic regression analysis were used to determine the independent risk factors of CDI. Results Amongthe 877 patients, the GDH antigen were positive in 205 patients. A total of 46 patients were diagnosed with CDI. The age was significantly higher in patients with CDI than in those normal cases(69.3±14.1 years vs 59.5±16.6 years),the difference was statistically significant(t=3.403, P<0.05). There were statistically significant differences in pulmonary infection, length of hospital stay and use of broad-spectrum antibiotic(χ²=10.120,10.477,21.080, P<0.05).The hemoglobin and albumin levels were significantly lower in patients with CDI than in those normal cases(102.1±29.8 g/L vs 113.3±25.7 g/L, 30.3±6.4 g/L vs 34.7±6.8g/L),the difference was statisticall significant(t=-2.285, -3.520, P< 0.05). Multivariate Logistic regression analysis indicated age and the use of broad-spectrum antibiotic within 30 days were factors independently correlated to CDI(OR=1.042, 29.274, P<0.05). Conclusion It is of great clinical value to detect the GDH antigen and toxin ofClostridium difficile in diarrheapatients. Attention should be paid to the occurrence of CDI in the elderly and using broad-spectrum antibiotics diarrhea patients.