恶性肿瘤患者艰难梭菌感染相关性腹泻的临床特征分析
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摘要
目的恶性肿瘤患者腹泻发生率较高,艰难梭菌感染为其中一个重要的原因,但临床辨别相对困难。本研究拟探讨恶性肿瘤患者艰难梭菌感染相关性腹泻的临床特征。方法回顾性分析472例恶性肿瘤合并腹泻患者,根据患者是否感染艰难梭菌分为艰难梭菌感染阳性组(A组,95例)和艰难梭菌感染阴性组(B组,377例)。采用进行聚合酶链式反应(PCR)检测艰难梭菌毒素A(tcd A)和艰难梭菌毒素B(tcd B);采用倾向值匹配法对研究中非研究混杂因素进行类似随机化的均衡处理。卡钳值设定为0.1,2组按照1∶1的比例进行匹配。记录2组患者一般情况和恶性肿瘤治疗情况等。结果 2组患者倾向值匹配完成后,每组共有91例患者纳入研究。A组患者与B组患者一般资料差异均无统计学意义(均P>0.05);A组患者血浆白蛋白水平明显低于B组(P<0.01),抗生素应用比例、质子泵抑制剂应用比例化疗、便潜血阳性比例和化疗后体能状态(ECOG)评分明显高于B组(均P<0.05);2组患者不良反应发生情况差异无统计学意义(P>0.05)。结论恶性肿瘤艰难梭菌感染相关性腹泻患者血浆白蛋白水平下降、便潜血阳性增加。抗生素、化疗和质子泵抑制剂的使用可能会增加恶性肿瘤患者艰难梭菌感染几率。
Objective The incidence rate of diarrhea in patients with malignant tumor is high. The Clostridium difficile infection is an important cause. However,it is difficult to distinguish clinically. This study intended to investigate the clinical characteristics for Clostridium difficile-associated diarrhea among cancer patients in China. Methods We investigated the prospective clinical database for cancer patients combined with diarrhea,and a total of 472 patients included in this study,who were divided into 2 groups depending on whether or not Clostridium difficile infection: Clostridium difficile infection group( Group A,n = 95) and Non-Clostridium difficile infection group( Group B,n = 377). Polymerase chain reaction( PCR) was used to detect the Clostridium difficile poison A( tcd A) and Clostridium difficile poison B( tcd B). The patient general information was recorded,blood routine examination and biochemical test were performed. The ECOG score was recorded before chemotherapy and during diarrhea. The side effects,chemoradiotherapy,proton pump inhibitor and antibiotic therapy within 4 weeks before diarrhea,the time of antibiotic therapy were also recorded. Propensity score matching analysis with preset caliper width 0. 1 was used to keep the equilibrium in general information between groups,and the two groups were matched with 1∶ 1. The general information and malignant tumor treatment information of the patients were recorded. Results A total of 91 matched pairs were selected from the patients after the propensity score matching analysis,and no difference was found in general information between Group A and Group B( P > 0. 05).Compared with Group B,the level of plasma albumin decreased in Group A( P < 0. 01),the proportion of antibiotic application,proton pump inhibitor,positive fecal occult blood test and ECOG score after chemotherapy were increased in Group A( P < 0. 05 or P < 0. 01). No difference was found in side effects between two groups. Conclusion The level of plasma albumin decreased and the incidence of positive fecal occult blood test increased in patients with malignant tumor associated diarrhea of Clostridium difficile infection. The use of antibiotics,chemotherapy and proton pump inhibitors may increase the risk of Clostridium difficile infection in patients with malignant tumors.
Objective The incidence rate of diarrhea in patients with malignant tumor is high. The Clostridium difficile infection is an important cause. However,it is difficult to distinguish clinically. This study intended to investigate the clinical characteristics for Clostridium difficile-associated diarrhea among cancer patients in China. Methods We investigated the prospective clinical database for cancer patients combined with diarrhea,and a total of 472 patients included in this study,who were divided into 2 groups depending on whether or not Clostridium difficile infection: Clostridium difficile infection group( Group A,n = 95) and Non-Clostridium difficile infection group( Group B,n = 377). Polymerase chain reaction( PCR) was used to detect the Clostridium difficile poison A( tcd A) and Clostridium difficile poison B( tcd B). The patient general information was recorded,blood routine examination and biochemical test were performed. The ECOG score was recorded before chemotherapy and during diarrhea. The side effects,chemoradiotherapy,proton pump inhibitor and antibiotic therapy within 4 weeks before diarrhea,the time of antibiotic therapy were also recorded. Propensity score matching analysis with preset caliper width 0. 1 was used to keep the equilibrium in general information between groups,and the two groups were matched with 1∶ 1. The general information and malignant tumor treatment information of the patients were recorded. Results A total of 91 matched pairs were selected from the patients after the propensity score matching analysis,and no difference was found in general information between Group A and Group B( P > 0. 05).Compared with Group B,the level of plasma albumin decreased in Group A( P < 0. 01),the proportion of antibiotic application,proton pump inhibitor,positive fecal occult blood test and ECOG score after chemotherapy were increased in Group A( P < 0. 05 or P < 0. 01). No difference was found in side effects between two groups. Conclusion The level of plasma albumin decreased and the incidence of positive fecal occult blood test increased in patients with malignant tumor associated diarrhea of Clostridium difficile infection. The use of antibiotics,chemotherapy and proton pump inhibitors may increase the risk of Clostridium difficile infection in patients with malignant tumors.
引文
[1]廖亚龙,侯铁英,邵裕燊,等.艰难梭菌感染临床特征与危险因素分析[J].中华医院感染学杂志,2016,26(21):4837-4840.
[2]陈晓丽,侯铁英,陈柳勤,等.艰难梭菌感染患者的临床特征分析[J].广东医学,2016,37(z2):28-30.
[3]干铁儿,金慧,吴建浓,等.血液病患者产毒素艰难梭菌定植与感染的危险因素研究[J].中华医院感染学杂志,2016,26(23):5305-5307.
[4]白驹,雷雨婷,张吉波.艰难梭菌相关性腹泻的临床特点分析和防治策略[J].中外医学研究,2013,11(25):1-2.
[5]马坚,俞万钧,彭卫东,等.艰难梭菌感染复发的临床预测与危险因素荟萃分析[J].中华医院感染学杂志,2015,25(11):2520-2523.
[6]李洪涛,曹守根,周岩冰.艰难梭菌感染研究进展[J].中国感染控制杂志,2015,14(11):789-792.
[7]Inoue S.Tracheal intubation by trainees does not alter the incidence or duration of postoperative sore throat and hoarseness:a teaching hospital-based propensity score analysis[J].Br J Anaesth,2015,115(3):463-469.
[8]倪婷婷,严敏,郁丽娜,等.右美托咪定对体外循环下心脏手术后患者预后的影响[J].中华麻醉学杂志,2016,36(7):785-789.
[9]王晓辉,宗志勇.艰难梭菌感染现状与预防措施[J].中华临床感染病杂志,2016,9(3):213-223.
[10]章黎华,李贞,江岑,等.3种检测艰难梭菌方法的临床应用评估[J].微生物与感染,2016,11(1):24-27.
[11]王中兴,周天祥,甄建新,等.艰难梭菌婴幼儿分离株毒力及基因型分布研究[J].临床检验杂志,2016,34(1):27-30.
[12]陆晓凤,吴建祥,徐少毅,等.重症加强治疗病房腹泻患者艰难梭菌检测的敏感方法[J].中华危重病急救医学,2015,27(6):525-526.
[13]Salazarkagunye R,Shah A,Loshkajian G,et al.Association of decreased serum protein fractions with Clostridium difficile infection in the acute care setting:a case-control study[J].Biomark Med,2012,6(5):663-669.
[14]童舟,罗芸,刘璐璐,等.艰难梭菌感染对结直肠癌患者营养及代谢的影响[J].中华危重症医学杂志(电子版),2016,9(4):217-221.
[15]谢和宾,曾鸿,尹柯,等.我国住院腹泻患者艰难梭菌感染率的荟萃分析[J].中华医院感染学杂志,2017,27(5):961-964.
[16]朱苗苗,李慧兰,罗佳,等.质子泵抑制剂的使用与艰难梭菌感染风险相关性的Metaeta分析[J].中国循证医学杂志,2016,16(3):278-285.
[17]陈熔,吕晓菊.艰难梭菌毒素的研究进展[J].中国抗生素杂志,2016,41(4):316-320.
[18]Dancer SJ,Kirkpatrick P,Corcoran DS,et al.Approaching zero:temporal effects of a restrictive antibiotic policy on;hospital-acquired Clostridium difficile,extended-spectrum;beta-lactamase-producing coliforms and meticillin-resistant;Staphylococcus aureus[J].Int J Antimicrob Agentsts,2013,41(2):137-142.
[19]Evans CT,Johnson S.Prevention of Clostridium difficile Infection With Probiotics[J].Clin Infect Dis,2015,60(suppl 2):S122-128.
[20]Lau CS,Chamberlain RS.Probiotics are effective at preventing Clostridium difficile-associated diarrhea:a systematic review and meta-analysis[J].Int J Gen Med,2016,9(2):27-37.
[21]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.
[2]陈晓丽,侯铁英,陈柳勤,等.艰难梭菌感染患者的临床特征分析[J].广东医学,2016,37(z2):28-30.
[3]干铁儿,金慧,吴建浓,等.血液病患者产毒素艰难梭菌定植与感染的危险因素研究[J].中华医院感染学杂志,2016,26(23):5305-5307.
[4]白驹,雷雨婷,张吉波.艰难梭菌相关性腹泻的临床特点分析和防治策略[J].中外医学研究,2013,11(25):1-2.
[5]马坚,俞万钧,彭卫东,等.艰难梭菌感染复发的临床预测与危险因素荟萃分析[J].中华医院感染学杂志,2015,25(11):2520-2523.
[6]李洪涛,曹守根,周岩冰.艰难梭菌感染研究进展[J].中国感染控制杂志,2015,14(11):789-792.
[7]Inoue S.Tracheal intubation by trainees does not alter the incidence or duration of postoperative sore throat and hoarseness:a teaching hospital-based propensity score analysis[J].Br J Anaesth,2015,115(3):463-469.
[8]倪婷婷,严敏,郁丽娜,等.右美托咪定对体外循环下心脏手术后患者预后的影响[J].中华麻醉学杂志,2016,36(7):785-789.
[9]王晓辉,宗志勇.艰难梭菌感染现状与预防措施[J].中华临床感染病杂志,2016,9(3):213-223.
[10]章黎华,李贞,江岑,等.3种检测艰难梭菌方法的临床应用评估[J].微生物与感染,2016,11(1):24-27.
[11]王中兴,周天祥,甄建新,等.艰难梭菌婴幼儿分离株毒力及基因型分布研究[J].临床检验杂志,2016,34(1):27-30.
[12]陆晓凤,吴建祥,徐少毅,等.重症加强治疗病房腹泻患者艰难梭菌检测的敏感方法[J].中华危重病急救医学,2015,27(6):525-526.
[13]Salazarkagunye R,Shah A,Loshkajian G,et al.Association of decreased serum protein fractions with Clostridium difficile infection in the acute care setting:a case-control study[J].Biomark Med,2012,6(5):663-669.
[14]童舟,罗芸,刘璐璐,等.艰难梭菌感染对结直肠癌患者营养及代谢的影响[J].中华危重症医学杂志(电子版),2016,9(4):217-221.
[15]谢和宾,曾鸿,尹柯,等.我国住院腹泻患者艰难梭菌感染率的荟萃分析[J].中华医院感染学杂志,2017,27(5):961-964.
[16]朱苗苗,李慧兰,罗佳,等.质子泵抑制剂的使用与艰难梭菌感染风险相关性的Metaeta分析[J].中国循证医学杂志,2016,16(3):278-285.
[17]陈熔,吕晓菊.艰难梭菌毒素的研究进展[J].中国抗生素杂志,2016,41(4):316-320.
[18]Dancer SJ,Kirkpatrick P,Corcoran DS,et al.Approaching zero:temporal effects of a restrictive antibiotic policy on;hospital-acquired Clostridium difficile,extended-spectrum;beta-lactamase-producing coliforms and meticillin-resistant;Staphylococcus aureus[J].Int J Antimicrob Agentsts,2013,41(2):137-142.
[19]Evans CT,Johnson S.Prevention of Clostridium difficile Infection With Probiotics[J].Clin Infect Dis,2015,60(suppl 2):S122-128.
[20]Lau CS,Chamberlain RS.Probiotics are effective at preventing Clostridium difficile-associated diarrhea:a systematic review and meta-analysis[J].Int J Gen Med,2016,9(2):27-37.
[21]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.