中华检验医学杂志
中華檢驗醫學雜誌
중화검험의학잡지
CHINESE JOURNAL OF LABORATORY MEDICINE
2014年
11期
855-860
,共6页
陈伟%刘文恩%简子娟%李艳明%李艳华%罗珊%钟一鸣
陳偉%劉文恩%簡子娟%李豔明%李豔華%囉珊%鐘一鳴
진위%류문은%간자연%리염명%리염화%라산%종일명
腹泻%梭菌,难辨%细菌毒素类%核糖体基因型%流行病学,分子
腹瀉%梭菌,難辨%細菌毒素類%覈糖體基因型%流行病學,分子
복사%사균,난변%세균독소류%핵당체기인형%류행병학,분자
Diarrhea%Clostridium difficile%Bacterial toxins%Ribotyping%Epidemiology,molecular
目的：初步研究湘雅医院艰难梭菌临床分离株的病原学、毒素基因携带情况及核糖体分型情况，并对其临床特征进行分析，为临床提高艰难梭菌分离率以及采取积极有效的防控措施奠定基础。方法采用前瞻性研究，收集中南大学湘雅医院2012年6至12月腹泻患者粪便标本452份，对其进行选择性厌氧培养及API20A鉴定，并对阳性标本进行毒素基因检测（ tcdA、tcdB、cdtA、cdtB）和核糖体分型（16S-23S间隔区多态性）；收集所有患者临床资料，并对其进行Logistic回归分析筛选其发病高危因素。结果艰难梭菌检出率13.94％（63／452），其中42.86％（36／63）为 A－B＋型，14.29％（9／63）来自社区感染，二元毒素基因检测均为阴性；共检出11种核糖体型，其中CD017最常见，占22.22％（14／63）；Logistic回归分析显示，年龄＞55（ P＝0.016； OR＝4.45；95％CI：1.33～14.91），腹泻次数（P＝0.007；OR＝0.03；95％CI：0.002～0.38）及腹泻持续时间（P＝0.015； OR＝7.86；95％CI：1.50～41.16）为其发病高危因素。结论艰难梭菌是湘雅医院腹泻患者重要致病菌，主要来自医院感染，A－B＋型检出率较高；核糖体分型存在相对优势型别CD017，无证据提示存在艰难梭菌感染的暴发流行。
目的：初步研究湘雅醫院艱難梭菌臨床分離株的病原學、毒素基因攜帶情況及覈糖體分型情況，併對其臨床特徵進行分析，為臨床提高艱難梭菌分離率以及採取積極有效的防控措施奠定基礎。方法採用前瞻性研究，收集中南大學湘雅醫院2012年6至12月腹瀉患者糞便標本452份，對其進行選擇性厭氧培養及API20A鑒定，併對暘性標本進行毒素基因檢測（ tcdA、tcdB、cdtA、cdtB）和覈糖體分型（16S-23S間隔區多態性）；收集所有患者臨床資料，併對其進行Logistic迴歸分析篩選其髮病高危因素。結果艱難梭菌檢齣率13.94％（63／452），其中42.86％（36／63）為 A－B＋型，14.29％（9／63）來自社區感染，二元毒素基因檢測均為陰性；共檢齣11種覈糖體型，其中CD017最常見，佔22.22％（14／63）；Logistic迴歸分析顯示，年齡＞55（ P＝0.016； OR＝4.45；95％CI：1.33～14.91），腹瀉次數（P＝0.007；OR＝0.03；95％CI：0.002～0.38）及腹瀉持續時間（P＝0.015； OR＝7.86；95％CI：1.50～41.16）為其髮病高危因素。結論艱難梭菌是湘雅醫院腹瀉患者重要緻病菌，主要來自醫院感染，A－B＋型檢齣率較高；覈糖體分型存在相對優勢型彆CD017，無證據提示存在艱難梭菌感染的暴髮流行。
목적：초보연구상아의원간난사균림상분리주적병원학、독소기인휴대정황급핵당체분형정황，병대기림상특정진행분석，위림상제고간난사균분리솔이급채취적겁유효적방공조시전정기출。방법채용전첨성연구，수집중남대학상아의원2012년6지12월복사환자분편표본452빈，대기진행선택성염양배양급API20A감정，병대양성표본진행독소기인검측（ tcdA、tcdB、cdtA、cdtB）화핵당체분형（16S-23S간격구다태성）；수집소유환자림상자료，병대기진행Logistic회귀분석사선기발병고위인소。결과간난사균검출솔13.94％（63／452），기중42.86％（36／63）위 A－B＋형，14.29％（9／63）래자사구감염，이원독소기인검측균위음성；공검출11충핵당체형，기중CD017최상견，점22.22％（14／63）；Logistic회귀분석현시，년령＞55（ P＝0.016； OR＝4.45；95％CI：1.33～14.91），복사차수（P＝0.007；OR＝0.03；95％CI：0.002～0.38）급복사지속시간（P＝0.015； OR＝7.86；95％CI：1.50～41.16）위기발병고위인소。결론간난사균시상아의원복사환자중요치병균，주요래자의원감염，A－B＋형검출솔교고；핵당체분형존재상대우세형별CD017，무증거제시존재간난사균감염적폭발류행。
Objective A preliminary study on the etiology , the gene typing , the PCR-ribotyping and the clinical features of Clostridium difficile from clinical isolates at Xiangya Hospital could improve the isolation rate and provide the basis for effectively prevention of C.difficile.Methods A prospective observational study was performed.A total of 452 stool samples were collected during June to December 2012 at Xiangya Hospital.All stools were anaerobic cultured by selective medium and identified by API 20A for C.difficile.The positive isolates were detected the toxin genes ( tcdA, tcdB, cdtA, cdtB ) and ribotyping (16S-23S internal spacer region ) by PCR.The clinical data of all patients were collected and analyzed through Logistic regression to discover the risk factors for the development of C.difficile infection ( CDI ) . Results The rate of CDI occurrence was 13.94%(63/452), among them, 42.86%(36/63) were A-B+strains and only 14.29%(9/63) were obtained from community acquired-CDI.No binary toxin was detected in any of the isolates.Eleven different PCR ribotypes were identified , the dominant ribotype CD017 accounted for 22.22%(14/63).Logistic regression analysis showed that the risk factors for CDI included age>55(P=0.016;OR=4.45;95%CI:1.33-14.91), diarrhea frequency(P=0.007, OR=0.03;95%CI:0.002 -0.38 ) and the duration of diarrhea ( P =0.015; OR =7.86; 95%CI: 1.50 -41.16 ) . Conclusions C.difficile is the main pathogens of diarrhea patients and is mainly from hospital infections with higher detection rate of A -B+ in Xiangya Hospital.Ribotyping exist comparative advantages type CD017.No evidence suggests outbreak of C.difficile infection.
