恶性肿瘤患者艰难梭菌相关性腹泻的临床危险因素分析

摘要

Objective The aim of this study was to investigate the prevalence of Clostridium difficile (C.difficile) infection and the risk factors for acquisition of C.difficile-associated diarrhea(CDAD) among cancer patients who received chemotherapy or radiation therapy.Methods We analyzed 277 stool samples from cancer patients with diarrhea between Sep 2010 and Dec 2011 in our hospital.Stool C.difficile toxin A/B test,stool culture for C.difficile and routine stool examination were performed.In addition,the risk factors for CDAD were investigated in a set of 41 C.difficile toxin-positive cancer patients and 82 matched C.difficile toxin-negative controls by univariate analysis and multivariate analysis.Results Out of a total of 277 cancer patients with diarrhea,41 (14.8％) were C.difficile toxin-positive.Among these 41 cases,11 (26.8％,11/41) were C.difficile culture-positive.Univariate analysis showed that antibiotics use(P =0.853),proton pump inhibitor use(P =0.718),hypoproteinemia (P =0.139) and white blood cell count (P =0.454) did not appear to be associated with acquisition of CDAD in cancer patients.However,receiving chemotherapy (P =0.023),receiving radiotherapy (P =0.003),a positive fecal occult blood test result(P =0.005) and the presence of fecal leukocytes (P =0.007) showed close association with acquisition of CDAD in cancer patients.Multivariate analysis showed that receiving chemotherapy (OR,8.308;95％ CI,1.997-34.572;P =0.004) and a positive result of fecal occult blood test(OR,8.475; 95％ CI,1.463-49.109;P =0.017) were independent risk factors for acquisition of CDAD among cancer patients.Conclusions Our results support that receiving chemotherapy and a positive fecal occult blood test result are independent risk factors for acquisition of CDAD among cancer patients.Cancer patients who are at high-risk for CDAD should take stool C.difficile toxin A/B test and stool culture for C.difficile regularly and prevention of CDAD.%目的 探讨肿瘤患者中艰难梭菌相关性腹泻(CDAD)的发病情况及其危险因素.方法 收集2010年9月至2011年12月间277例恶性肿瘤患者腹泻的粪便标本,进行艰难梭菌毒素A/B检测、粪便厌氧培养和粪便常规检测,并对艰难梭菌阳性患者的临床病理特征和实验室检查结果进行单因素和多因素分析.结果 277例肿瘤腹泻患者中,共检出艰难梭菌毒素阳性者41例(14.8％),其中艰难梭菌毒素检测和艰难梭菌培养同时阳性11例,占26.8％(11/41).单因素分析结果显示,应用抗生素、应用质子泵抑制剂、低蛋白血症和全血白细胞水平与肿瘤患者CDAD的发生均无关(均P＞0.05);肿瘤患者接受化疗、接受放疗、粪便潜血阳性和粪便白细胞镜检阳性与CDAD的发生均有关(均P＜0.05).多因素分析结果显示,接受化疗和粪便潜血阳性是肿瘤患者发生CDAD的独立危险因素(均P＜0.05).结论 接受化疗、粪便潜血阳性是肿瘤患者发生CDAD的独立危险因素.应定期对接受化疗和粪便潜血阳性的肿瘤患者进行粪便艰难梭菌毒素A/B检测和厌氧培养,预防CDAD的发生.