上海部分地区儿童艰难梭菌相关性腹泻的临床分析  

Clinical analysis of Clostridium difficile-associated diarrhea in children from part of Shanghai

作　　者：冯云[1] 王传清[2] 金嘉琳[1] 张文宏[1] 

机构地区：[1]复旦大学附属华山医院感染科,上海200040 [2]复旦大学附属儿科医院细菌室,上海201102

出　　处：《微生物与感染》2010年第3期151-155,共5页Journal of Microbes and Infections

基　　金：益普生腹泻基金(IDF-2007-02);国家"十一五"重大传染病专项(2009ZX10004104)

摘　　要：本文旨在监测儿童腹泻中艰难梭菌相关性腹泻(CDAD)的发病情况,并对其进行回顾性临床分析。对复旦大学附属儿科医院2007年2月～9月111例腹泻患儿的粪便标本进行艰难梭菌毒素A检测及粪便厌氧菌培养,对所有患儿进行回顾性病史采集及分析,并对粪便培养所得的4株艰难梭菌菌株用多位点可变数目串联重复序列分析(MLVA)技术进行同源性分析。111例患者中,艰难梭菌毒素A检测及艰难梭菌培养均为阳性者无,艰难梭菌毒素A阳性而艰难梭菌培养阴性者16例,艰难梭菌毒素A阴性而艰难梭菌培养阳性者4例,艰难梭菌毒素A及艰难梭菌培养均阴性者91例。比较院内、院外组3种不同病程腹泻CDAD的发病率,无显著差异。MLVA分析发现粪便培养得到的4株艰难梭菌菌株有部分同源性。结果提示,目前上海部分地区儿童CDAD发病情况为散发,但彼此之间有部分同源性;院内、外获得性腹泻的CDAD发病率无显著差异;艰难梭菌毒素A阳性或艰难梭菌培养阳性的病例在临床表现上与艰难梭菌毒素A阴性且艰难梭菌培养阴性的腹泻病例无显著差异。The present paper aims to explore the incidence of Clostridium difficile-associated diarrhea （CDAD）among children with diarrhea using a retrospective clinical analysis.A total of 111children with diarrhea from February 2007to September 2007in Children＇s Hospital of Fudan University were included in the study.An enzyme-linked immunosorbent assay（ELISA）-based assay of Clostridium difficile toxin A was used to detect the bacteria in their stool samples;anaerobic bacteria culture was also performed for each sample.Four cultured Clostridium difficile strains were isolated and subjected to multiple-locus variablenumber tandem repeat analysis（MLVA）for homology analysis.No cases tested positive for both toxin A and culture,16cases were positive for toxin A but negative for culture,4cases were negative for toxin A but positive for culture,and 91cases were negative for both toxin A and culture.The incidence of CDAD between hospital-acquired and community-acquired infection was not significantly different.The four cultured Clostridium difficile isolates were partly homologous in the phylogenetic tree.These results suggest that Clostridium difficile infection in Shanghai is sporadic,and may be partly homologous to some extent.The clinical manifestation of diarrhea found with CDAD is not different from that not caused by Clostridium difficile.

关 键 词：艰难梭菌 毒素A 腹泻 多位点可变数目串联重复序列分析 儿童 

分 类 号：R725.1[医药卫生—儿科]