难辨梭状芽孢杆菌相关性腹泻的中西医治疗进展  

Treatment of Clostridium difficile-associated diarrhea

作　　者：李丹[1] 任爱民[1] 

机构地区：[1]首都医科大学附属北京友谊医院感染内科,北京市100050

出　　处：《世界华人消化杂志》2012年第6期497-504,共8页World Chinese Journal of Digestology

摘　　要：难辨梭状芽孢杆菌相关性腹泻(Clostridium difficile-associated diarrhea,CDAD)是由难辨梭状芽孢杆菌感染引起的腹泻,是抗生素相关性腹泻中的一个严重亚型.近年来,CDAD因其发病率及严重程度逐年增高,受到各国专家的普遍关注.目前在美国、加拿大和欧洲等国家CDAD的发病率和严重程度显著增加,甚至出现暴发流行.难辨梭状芽孢杆菌是一种革兰阳性肠道病原体,可产生毒素A和毒素B,侵入肠黏膜后引起细胞病变,导致一系列感染相关临床表现.其发病绝大多数与近期内接受广谱抗生素治疗有关,但高龄、慢性病史、长期住院等因素亦为该病发生的危险因素.一旦确诊或高度怀疑本病,应立即停用原有抗生素或换用其他不易导致CDAD的药物,同时应用甲硝唑或万古霉素治疗.近期相关研究表明,除甲硝唑、万古霉素外,还可应用替考拉宁、微生态制剂、单克隆抗体、复方中药制剂等治疗CDAD.本文就难辨梭状芽孢杆菌相关性腹泻的危险因素、治疗与预防方法等研究进展作一综述.Clostridium difficile-associated diarrhea（CDAD） is a serious subtype of antibiotic-associated diarrhea.In recent years,the incidence and severity of CDAD have significantly increased worldwide.Clostridium difficile is a Gram-positive enteric pathogen and can produce toxin A and toxin B,which induce cytopathic changes and lead to a series of clinical manifestations of infection.Although the use of broad spectrum antibiotics is the most common cause for the development of CDAD,age,chronic disease,long-term hospitalization and other factors are also possible risk factors.Patients with confirmed or highly suspected CDAD should immediately discontinue antibiotics and switch to other drugs which do not tend to cause CDAD.Treatment with metronidazole or vancomycin is recommended.Recent studies show that teicoplanin,probiotics,monoclonal antibody and Chinese medicine are also effective for this disease.In this paper,we discuss the prevention and treatment of CDAD.

关 键 词：难辨梭状芽孢杆菌相关性腹泻 治疗 预防 危险因素 

分 类 号：R574[医药卫生—消化系统]