22例伪膜性结肠炎临床特征分析

背景:我国不合理使用抗生素的现象严重,抗生素相关性腹泻如伪膜性结肠炎(PMC)的发病率呈上升趋势。目的:综合分析PMC的临床特征以提高其诊治水平。方法:收集2007年6月～2012年2月于湖南省人民医院住院治疗,经结肠镜检查确诊的PMC患者,对其病史资料进行回顾性分析。结果:共22例PMC患者纳入研究,其中70岁以上者18例(81.8%),18例患者存在基础疾病。所有患者均于使用抗生素过程中出现腹泻,并可伴有不同程度的腹痛、发热、血便等其他症状。使用头孢菌素类抗生素者最多见(14例),20例患者联合使用两种或两种以上抗生素。21例接受结肠镜检查者均可见典型伪膜样病灶,内镜分型轻度9例,中度7例,重度5例。经停用原有抗生素以及使用甲硝唑、万古霉素、益生菌制剂等治疗后,21例患者好转出院。结论:PMC多发生于有基础疾病的老年人,病程早期缺乏特异性临床表现。结肠镜检查是诊断PMC的重要手段之一,确诊后应尽早停用原有抗生素,使用足量、足疗程的甲硝唑和万古霉素以及益生菌制剂。

Clinical Characteristics of Pseudomembranous Colitis: Analysis of 22 Cases

Because of the irrational use of antibiotics, the incidence of antibiotic-assoclated diarrhea such as pseudomembranous colitis （PMC） is increasing in China. Aims： To analyze the clinical characteristics of PMC for improving its diagnosis and management. Methods： Patients with endoscopy-proved PMC admitted from Jun. 2007 to Feb. 2012 at HuMan Provincial People＇s Hospital were enrolled and retrospectively analyzed. Results： A total of 22 PMC patients met the inclusion criteria. Of them, 18 （ 81.8% ） were over 70 years old and 18 coexisted with underlying diseases. All patients experienced diarrhea and some also had other symptoms, such as abdominal pain, fever, bloody stool during the course of antibiotic treatment. Cephalosporins was the most commonly used antibiotics （ 14 cases）, and 20 patients used two or more antibiotics. Twenty-one patients received colonoscopy and showed typical pseudomembrane. Of them, 9 were classified as mild disease, 7 were moderate disease, and 5 were severe disease endoscopically. When antibiotics were withdrawn, and metronidazole, vancomycin and probiotic preparations were used, 21 patients were cured and discharged. Conclusions： PMC mainly occurs in aged people with underlying diseases. The clinical manifestations are nonspecific in early stage. Colonoscopy is the main approach for the diagnosis of PMC. Cessation of antibiotics, as well as full dosage and full course of metronidazole, vancomycin and probiotic preparations are necessary for the treatment of PMC.