复发的炎症性肠病患者中艰难梭菌的临床实验室检测  

Direct fecal detection of Clostridium difficile in patients with recurrent inflammatory bowel disease

作　　者：杨菁玉 王晓辉[1,3] 黄亮[1,4] 俞汝佳[1,3] 宗志勇[1,3,5] 

机构地区：[1]四川大学华西医院感染性疾病中心,成都610041 [2]四川省医学科学院.四川省人民医院老年感染科,成都610072 [3]四川大学华西医院生物治疗国家重点实验室感染性疾病研究室,成都610041 [4]成都市公共卫生临床医疗中心传染三病区,成都610066 [5]四川大学华西医院医院感染管理部,成都610041

出　　处：《华西医学》2017年第3期324-328,共5页West China Medical Journal

基　　金：四川省科学技术厅科研课题(2015SZ0234-4)

摘　　要：目的探索2种用于临床实验室快速检测的方法——核酸粪便直接检测和酶免疫测定(enzyme immunoassay,EIA)粪便直接检测,在复发的炎症性肠病(inflammatory bowel disease,IBD)患者中识别艰难梭菌感染(Clostridium difficile infection,CDI)的临床应用,为艰难梭菌的医院感染防控提供支持。方法收集2014年11月—2015年4月入院复发的48例IBD患者入院48 h内自然解出的粪便,使用粪便厌氧培养和鉴定、核酸粪便直接检测和EIA粪便直接检测3种方法分别检测同一样本。采用Κappa一致性检验方法对检测结果进行统计学分析。结果 48份样本中,共有37份不含有艰难梭菌的样本和11份含艰难梭菌的样本,其中含有产毒艰难梭菌的样本2份,占4.2%。2株产毒艰难梭菌的毒素类型均为A+B+。一致性检验表明与厌氧培养和鉴定法相比,核酸粪便直接检测法与其一致性最好(Κappa=1.00,P<0.05);EIA粪便直接检测法在识别是否有艰难梭菌的样本方面与其一致性也很高(Κappa=0.89,P<0.05)。但EIA粪便直接检测法对含产毒的艰难梭菌样本进行毒素检测时会漏检。结论除了厌氧培养和鉴定以外,核酸粪便直接检测和EIA粪便直接检测都可以用于IBD患者合并CDI的筛查,前者较后者略好。临床上高度怀疑IBD合并CDI的患者,若粪便的EIA毒素检测阴性,建议加用核酸检测等其他方法进行确认。Objective To explore the application of two methods of direct fecal detection ofClostridium difficilein patients with recurrent inflammatory bowel disease （IBD）, including nucleic acid amplification test （NAAT） and enzyme immunoassay （EIA）, in order to provide support for hospitals to prevent and control clostridium difficile infection （CDI）. Methods Fresh feces of 48 patients with recurrent IBD treated between November 2014 and April 2015 were collected within 48 hours after admission. Anaerobic culture and identification, NAAT and EIA were used to test the same samples. Statistical analysis was performed using Kappa test. Results Among the 48 fecal samples,Clostridium difficilewas negative in 37 and positive in 11 including 2 （4.2%） with toxigenicClostridium difficile characterized as toxin type A＋B＋. Compared with anaerobic culture and identification, NAAT had a perfect correlation （Kappa=1.00,P〈0.05）, and EIA had an almost perfect correlation （Kappa=0.89,P〈0.05）. But EIA toxin test had missed detection of toxigenic samples. Conclusions For patients with recurrent IBD combined with CDI, both NAAT and EIA test may be applied to detctClostridium difficile in feces directly, while NAAT may show a better performance. Samples from highly suspected patients with negative toxin result tested by EIA should be confirmed by other methods such as NAAT.

关 键 词：炎性肠病 艰难梭菌 实验室快速检测 

分 类 号：R574[医药卫生—消化系统]