粪便微生物移植治疗幼儿重症伪膜性肠炎1例并文献复习  

One case of pediatric severepseudomembranous enteritis treated with fecal microbiota transplantation and literature review

作　　者：肖咏梅[1] 王佳怡[1] 车艳然 刘海峰[1] 张泓[2] 杨永臣[2] 胡志红[1] 张婷[1] 

机构地区：[1]上海交通大学附属儿童医院消化科,上海201102 [2]上海交通大学附属儿童医院检验科,上海201102

出　　处：《中国循证儿科杂志》2014年第1期37-40,共4页Chinese Journal of Evidence Based Pediatrics

基　　金：上海市浦江人才基金:12PJ1401500

摘　　要：目的探讨伪膜性肠炎患儿的诊断与治疗并介绍粪便微生物移植治疗。方法总结1例重症伪膜性肠炎患儿的临床表现、辅助检查、诊断及治疗,并对粪便微生物移植进行相关文献复习。结果①患儿,男,13月龄,以肠道感染,继发肠梗阻起病,间断腹泻2个月,全身水肿1个月入院。病程中外院曾实施剖腹探查+双侧腹股沟斜疝疝囊高位结扎术。入我院后诊断为蛋白丢失性肠病,重症伪膜性肠炎,电解质紊乱,代谢性酸中毒,营养不良等,予以各种对症支持治疗,并甲硝唑及万古霉素联合用药,并最终给予粪便微生物移植治疗,好转出院。②文献复习国外报道的成人伪膜性肠炎、复发性艰难梭菌感染及抗生素相关性腹泻的粪便微生物移植共217例,首次治疗完全缓解为191例(88.0%);复发9例,行第2次粪便微生物移植完全缓解为8例(88.9%)。回顾儿童粪便微生物移植1例,并结合本文病例了解粪便微生物移植流程及儿科应用。结论及时诊断及加强伪膜性肠炎的临床管理,在未取得充分儿童粪便微生物移植的安全性与有效性证据之前,在经验治疗失败或无效的伪膜性肠炎患儿中应用该方法仍需谨慎。Objective Pseudomembranous enteritis( PME) is an acute inflammatory bowel disease affecting pediatric population. The aim of this study was to discuss the characteristics,diagnosis,and management of pediatric PME,and the potential possibility of fecal microbiota transplantation( FMT) application in pediatric PME. Methods The clinical manifestations,laboratory testing, diagnosis,and treatment of one case with severe pediatric PME were reviewed,analyzed and summarized. Meanwhile,associated literatures of FMT were reviewed in this article. Results ①A 13-month-old boy admitted with 2-month diarrhea,half-month edema, hypoalbuminemia,and malnutrition. At the beginning,exploratory laparotomy and high ligation of inguinal hernia were performed. Multiple broad-spectrum antibiotics were daily introduced to this patient during 2 months. Protein-losing gastroenteropathy,severe PME,electrolyte disturbance and malnutrition were diagnosed and treated accordingly. For PME,the patient was treated with 10-day oral metronidazole plus vancomycin for twice,then FMT was performed via nasal jejunal feeding tube. The patient completely recovered and released. ② In total 143 published articles were reviewed,217 cases of recurrent Clostridium difficile infection, PME,and antibiotic associated diarrhae using FMT were included. 191( 88. 0%) patients recovered at the first time treated with FMT. 8 of 9( 88. 9%) recurrent patients who received the second FMT recovered. There was only one report of one pediatric PME case treated with FMT. Conclusion It needs more attention to pediatric PME during clinical practice. Although,FMT might be another practicable option for severe or recurrent PME cases that was failed with empirical therapy,it is recommended that this strategy should be taken cautiously to the complicated cases of PME until more data generated from randomized studies can confirm the safety and effectiveness of FMT.

关 键 词：伪膜性肠炎 艰难梭菌感染 粪便微生物移植 儿童 

分 类 号：R725.7[医药卫生—儿科]