艰难梭菌腹泻及实验室诊断

目的探讨艰难梭菌A&B毒素测定在临床应用价值,分析艰难梭菌毒素感染的临床特点。方法对四川大学华西医院2011-02/08收集的155份住院腹泻患者大便标本,采用VIDAS艰难梭菌A&B毒素检测试剂盒进行毒素检测。根据A&B毒素检测结果,将研究对象分为3组:艰难梭菌毒素检测阳性(CDAB阳性)组、艰难梭菌毒素检测灰区组和艰难梭菌毒素检测阴性组。对3组的实验室检测数据和临床资料进行分析比较,实验数据包括大便常规、血常规、生化检测以及粪便镜下微生物学检查,临床资料包括患者的年龄性别、使用抗生素与预后情况等。结果共检测了155例腹泻患者的大便标本,其中艰难梭菌A&B毒素阳性17例(10.97%),可疑6例(3.87%)。155例腹泻患者分为艰难梭菌毒素阳性、可疑和阴性3组进行实验室检测结果比较分析,大便隐血试验在阳性组和阴性组间有统计学差异(P=0.027)。3组病患的临床资料分析显示,抗真菌药物和质子泵抑制剂的使用可能是引起艰难梭菌感染的危险因素。结论艰难梭菌A&B毒素检测技术成熟并已商品化,该方法快速、简单、特异性高,可以作为艰难梭菌临床感染的辅助诊断指标。大便隐血试验可提示艰难梭菌感染,但不具有特异性。

Clinical Analysis and Laboratory Diagnosis of Clostridium(C.) Difficile-associated Diarrhea

Objective To analyze the clinical features and clinical risk factors related to Clostridium(C.) difficile toxin positive,and to discuss the clinical application values of C.difficile toxin A and B assay in diarrheal inpatients.Method The 155 fecal specimens,which were collected from diarrheal inpatients in West China Hospital,were tested by VIDAS C.difficile toxin A&B(CDAB)assay.According to the results of toxin A and B assays,the participants were classified into three groups,the C.difficile toxin positive,the suspicious(grey zone samples) and the toxin negative.The laboratory data and clinical information of the three groups were analyzed and compared together.The laboratory data includes stool and blood routine testing,biochemical testing and the fecal examination under microscope;the clinical information includes the ages,use of antibiotics and the prognosis of the patients,and so on.Results Of the 155 fecal specimens from diarrheal inpatients detected in this study,17(10.97%)were CDAB positive,6(3.87%)were suspicious.The 155 diarrheal patients were classified into three groups(the toxin positive,suspicious and negative group).The results of laboratory examination of the three groups were analyzed and compared,the fecal occult blood(OB) test had significant statistical differences between toxin positive group and negative one(P=0.027).The results of clinical information of the three groups indicated that antifungal drugs and proton pump inhibitors may be risk factors for C.difficile infection.Conclusions C.difficile toxin A and B assays was a mature technology and has been already commercialization,it appears to be a rapid,simple and highly specific method,which is expected to be prompted in clinical application.Among the indicators commonly used in the laboratory,fecal OB test may be prompted to C.difficile infection,but it was lack of specificity.