艰难梭菌感染与大肠癌及大肠腺瘤的相关性分析  

Correlation between Clostridium difficile infection and colorectal cancer and colorectal adenoma

作　　者：何莹[1] 黄崇杰[1] 诸葛林敏[1] 傅凌雪[1] 王奕英 赵蔚蔚 HE Ying;HUANG Chong-jie;ZHUGE Lin-min;FU Ling-xue;WANG Yi-ying;ZHAO Wei-wei(The Second Affiliated Hospital of Wenzhou Medical University,Wenzhou,Zhejiang 325000,China)

机构地区：[1]温州医科大学附属第二医院肛肠外科

出　　处：《中华医院感染学杂志》2019年第21期3216-3219,3224,共5页Chinese Journal of Nosocomiology

基　　金：温州市科技局基金资助项目(2013S0460)

摘　　要：目的研究艰难梭菌感染与大肠癌、大肠腺瘤的相关性。方法选择2015年9月-2018年5月温州医科大学附属第二医院收治的大肠腺瘤患者354例,为大肠腺瘤组;大肠癌患者257例,为大肠癌组;体检人群60例,为对照组。观察和记录三组对象艰难梭菌感染阳性率、毒素基因。建立多因素Logistic模型,分析有意义变量。结果大肠腺瘤组大肠癌家族史构成比3.39%,大肠癌组7.00%,对照组为0,三组构成比比较,差异有统计学意义(P<0.05)。大肠癌组艰难梭菌感染率12.06%高于大肠腺瘤组4.80%,大肠腺瘤组高于对照组,差异有统计学意义(P<0.05)。大肠癌组毒素A基因(+)毒素B基因(+)检出率90.32%、二元毒素A基因(+)二元毒素B基因(+)检出率6.45%,均高于大肠腺瘤组(P<0.05)。Logistic分析显示艰难梭菌感染是导致大肠腺瘤发生、进展为大肠癌高危风险因素。结论艰难梭菌感染与大肠腺瘤、大肠癌相关性,可能与毒素A基因、毒素B基因和二元毒素等细胞毒性作用于肠道黏膜上皮细胞而产生损伤、破坏效应机制有关,所以艰难梭菌感染在大肠癌发生、发展中具有关键作用。OBJECTIVE To explore the correlation between Clostridium difficile infection and colorectal cancer and colorectal adenoma.METHODS Totally 354 patients with colorectal adenoma who were treated in the Second Affiliated Hospital of Wenzhou Medical University from Sep 2015 to May 2018 were chosen as the colorectal adenoma group,257 patients who had colorectal cancer were assigned as the colorectal cancer group,and 60 people who received physical examination were set as the control group.The positive rate of C.difficile infection and toxin genes in the three groups of study objects were recorded and observed.Multivariate logistic model was established to analyze the variables with statistical significance.RESULTS The constituent ratio of family history of colorectal cancer was 3.39%in the colorectal adenoma group,7.00%in the colorectal cancer group,0 in the control group,and there was significant difference among the three groups(P<0.05).The incidence rate of C.difficile infection was 12.06%the colorectal cancer group,significantly higher than 4.80%in the colorectal adenoma group,the incidence rate of C.difficile infection of the colorectal adenoma group was significantly higher than that of the control group(P<0.05).The detection rate of toxin A gene(+)toxin B gene(+)was 90.32%in the colorectal cancer group,significantly higher than that in the colorectal adenoma group;the detection rate of binary toxin A gene(+)binary toxin B gene(+)was 6.45%in the colorectal cancer group,significantly higher than that in the colorectal adenoma group(P<0.05).The logistic analysis indicated that the C.difficile infection was the high risk factor for the colorectal adenoma and progression to colorectal cancer.CONCLUSION The C.difficile infection is associated with the colorectal adenoma and colorectal cancer,which may be related to the damage and destruction of effector mechanism due to the toxin A gene,toxin B gene and binary toxin’s acting on intestinal mucosal epithelial cells.The C.difficile infection plays a key role in the occ

关 键 词：大肠癌 大肠腺瘤 艰难梭菌感染 相关性 机理 

分 类 号：R735.3[医药卫生—肿瘤]