伴腹泻炎症性肠病患者感染难辨梭状芽孢杆菌的相关因素及其对短期预后的影响

摘要

目的 通过分析伴腹泻IBD患者难辨梭状芽孢杆菌感染(CDI)的情况,探讨其可能的危险因素及其对短期预后的影响.方法 纳入2013年1月至2015年6月于上海交通大学医学院附属瑞金医院就诊的169例伴腹泻IBD患者,另外纳入同期就诊的184例非IBD腹泻患者(对照组).收集纳入伴腹泻IBD患者的病历资料.采用酶免疫测定法检测所有纳入患者粪便中由难辨梭状芽孢杆菌产生的毒素A和B.统计学方法采用t检验、卡方检验和logistic回归分析.结果 169例伴腹泻IBD患者中,成人137例,儿童32例.伴腹泻IBD患者的CDI阳性率为9.5％ (16/169),高于非IBD腹泻组的1.1％ (2/184),差异有统计学意义(x2=12.785,P＜0.01).成人伴腹泻IBD患者的CDI阳性率为7.3％(10/137),伴腹泻IBD患儿的CDI阳性率为18.8％(6/32).16例CDI阳性的伴腹泻IBD患者中,10例入院前有外院住院史,其本次入院前住院率高于CDI阴性伴腹泻IBD患者的37.3％(57/153),差异有统计学意义(x2=2.875,P=0.01,OR=1.26,95％CI0.78 ～ 2.03).16例CDI阳性的伴腹泻IBD患者中,14例曾使用抗菌药物治疗,其使用率高于CDI阴性伴腹泻IBD患者的34.6％(53/153),差异有统计学意义(x2=14.778,P＜0.01,OR=24.74,95％CI 3.15 ～ 194.46).CDI阳性组和阴性组的伴腹泻IBD患者的住院时间、检测难辨梭状芽孢杆菌后6个月内的肠道切除手术率和英夫利西单克隆抗体使用情况差异均无统计学意义(P均＞0.05).结论 伴腹泻IBD患者CDI发生率升高,其危险因素包括入院前有住院史和使用抗菌药物,但CDI与IBD的短期预后无明显关系.%Objective To analyze the prevalence of Clostridium difficile infection (CDI) in patients with inflammatory bowel disease (IBD) accompanied with diarrhea in order to analyze the possible risk factors and its impact on short-term prognosis.Methods From January 2013 to June 2015,a total of 169 IBD patients with diarrhea who visited Rui Jin Hospital,School of Medicine,Shanghai Jiaotong University were enrolled,and in the same period 184 non-IBD patients with diarrhea were enrolled as control group.Clinical data of IBD patients with diarrhea were collected.Clostridium difficile toxins A and B of stool specimens of all included patients were detected with enzyme immunoassay.T test,chi-square test and logistic regression analysis were performed for statistical analysis.Results Among 169 IBD patients with diarrhea,there were 137 adults and 32 children.The positive rate of CDI of IBD patients with diarrhea (9.5％,16/169) was higher than that of non-IBD patients with diarrhea (1.1％,2/184),and the difference was statistically significant (x2 =12.785,P ＜ 0.0l).The positive rate of CDI in adults and children with IBD accompanied with diarrhea were 7.3％ (10/137),and 18.8％ (6/32),respectively.Among 16 CDI-positive IBD patients with diarrhea,10 patients had hospitalization history before admission,and the rate of previous hospitalizations was higher than that of CDI-negative IBD patients with diarrhea (37.3％,57/153),and the difference was statistically significant (x2 =2.875,P =0.01,odds ratio (OR) =1.26,95％ confidence interval (CI) 0.78 to 2.03).Furthermore,among 16 CDI-positive IBD patients with diarrhea,14 patients had been treated with antibiotic drugs before,the antibiotic utilization rate was higher than that of CDI-negative IBD patients with diarrhea (34.6％,53/153),and the difference was statistically significant (x2 =14.778,P ＜ 0.01,OR =24.74,95％ CI 3.15 to 194.46).However,there was no statistically significant difference in the length of hospitalization,incidence of bowel surgery and usage of inflaximab within six months after Clostridium difficile detection between the CDI-positive group and CDInegative group of 1BD patients with diarrhea (all P ＞ 0.05).Conclusions The incidence of CD1 in IBD patients with diarrhea increases.The risk factors include history of previous hospitalization before admission and antibiotic usage.However there is no significant correlation between CDI and short-term prognosis of IBD.