细菌培养法、ELFIA和PCR检测恶性肿瘤化疗期腹泻患者艰难梭菌的比较
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摘要
目的比较细菌培养法、酶联荧光免疫分析技术(ELFIA)检测艰难梭菌毒素A/B、PCR检测肠毒素(tcd)A/B对恶性肿瘤化疗期腹泻患者的艰难梭菌检出率,并分析艰难梭菌感染患者的临床特征。方法选择212例行恶性肿瘤化疗的腹泻患者为研究对象,分别采用粪便艰难梭菌培养、ELFIA检测艰难梭菌毒素A/B、PCR检测tcd A/B等3种方法,比较其艰难梭菌阳性检出率,并分析艰难梭菌感染患者的临床特征。结果粪便艰难梭菌培养、ELFIA检测艰难梭菌毒素A/B、PCR检测tcd A/B的阳性检出率分别为12.7%、10.4%和31.6%;PCR的阳性检出率明显高于其他2种方法(均P<0.05)。PCR检测艰难梭菌阳性的67例患者中男36例,女31例;年龄46~89(67.2±10.8)岁;合并心血管疾病或糖尿病等基础性疾病占86.6%;所有患者使用过广谱抗生素、质子泵抑制剂(PPIs);粪便潜血试验阳性占95.5%;平均血浆白蛋白浓度为37.92g/L,C反应蛋白为30.25mg/L。结论 PCR的阳性检出率最高。恶性肿瘤化疗患者若年龄较高、使用过广谱抗生素或PPIs和粪便潜血试验阳性合并腹泻时,应考虑艰难梭菌感染。
Objective To compare bacterial culture,enzyme-linked fluorescent immunoassay(ELFIA) and polymerase chain reaction(PCR) for detecting the clostridium difficile infection(CDI) in cancer patients with diarrhea during chemotherapy.Methods Two hundred and twelve cancer patients with diarrhea during chemotherapy were enrolled in this study.Positive detection rate of Clostridium difficile was compared among fecal bacterial culture,ELFIA for CD toxin A/B and PCR for ted A/B.The clinical features of the patients with CDI were also analyzed.Results The positive detection rates of bacteria culture,ELFIA and PCR were 12.7%,10.4%and 31.6%,respectively,and PCR was the most sensitive one(P<0.05).In 67 CDIpatients detected by PCR,36 were males and 31 females with a mean age of 67.2 ± 10.8 years,and 58(86.6%) were complicated with cardiovascular disease or diabetes.All patients had treatment with antibiotics and proton pump inhibitors.In all CDI patients,95.5%cases were found positive fecal occult blood test,and the average plasma albumin was 37.92g/L and C-reactive protein was 30.25mg/L.Conclusion Among the three detection methods for clostridium difficile,PCR is the most sensitive one.For elderly cancer patients having treatment with proton pump inhibitors and broad-spectrum antibiotics and with positive fecal occult blood test,if diarrhea occurs during the chemotherapy Clostridium difficile infection should be considered.
Objective To compare bacterial culture,enzyme-linked fluorescent immunoassay(ELFIA) and polymerase chain reaction(PCR) for detecting the clostridium difficile infection(CDI) in cancer patients with diarrhea during chemotherapy.Methods Two hundred and twelve cancer patients with diarrhea during chemotherapy were enrolled in this study.Positive detection rate of Clostridium difficile was compared among fecal bacterial culture,ELFIA for CD toxin A/B and PCR for ted A/B.The clinical features of the patients with CDI were also analyzed.Results The positive detection rates of bacteria culture,ELFIA and PCR were 12.7%,10.4%and 31.6%,respectively,and PCR was the most sensitive one(P<0.05).In 67 CDIpatients detected by PCR,36 were males and 31 females with a mean age of 67.2 ± 10.8 years,and 58(86.6%) were complicated with cardiovascular disease or diabetes.All patients had treatment with antibiotics and proton pump inhibitors.In all CDI patients,95.5%cases were found positive fecal occult blood test,and the average plasma albumin was 37.92g/L and C-reactive protein was 30.25mg/L.Conclusion Among the three detection methods for clostridium difficile,PCR is the most sensitive one.For elderly cancer patients having treatment with proton pump inhibitors and broad-spectrum antibiotics and with positive fecal occult blood test,if diarrhea occurs during the chemotherapy Clostridium difficile infection should be considered.
引文
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[7]Janarthanan S,Ditah I,Adler D G,et al.Clostridium difficile-associated diarrhea and proton pump inhibitor therapy:a metaanalysis[J].Am J Gastroenterol,2012,107(7):1001-1010.
[2]Gordon D,Young L R,Reddy S,et al.Incidence of Clostridium difficile infection in patients receiving high-risk antibiotics with or without a proton pump inhibitor[J].J Hosp Infect,2016,92(2):173-177.
[3]Voth D E,Ballard J D.Clostridium difficile toxins:mechanism ofaction and role in disease[J].Clin Microbiol Rev,2005,18(2):247-263.
[5]赵建宏,杨靖.艰难梭菌感染流行病学特征、实验室诊断与治疗的研究进展[J].临床检验杂志,2013,31(1):40-43.
[6]Yuan P,Zhang H,Cai C,et al.Chondroitin sulfate proteoglycan 4functions as the cellular receptor for Clostridium difficile toxin B[J].Cell Res,2014,25(2):157-168.
[6]朱宇,王力,冯莎娜,等.恶性肿瘤患者艰难梭菌相关性腹泻的临床危险因素分析[J].中华肿瘤杂志,2014,36(10):773-777.
[7]Janarthanan S,Ditah I,Adler D G,et al.Clostridium difficile-associated diarrhea and proton pump inhibitor therapy:a metaanalysis[J].Am J Gastroenterol,2012,107(7):1001-1010.