非新鲜腹泻粪便样本艰难梭菌检测方法的研究  

Study on detection method of Clostridium difficile in non-fresh diarrhea stool samples

作　　者：王浦[1] 陈烨[1] WANG Pu;CHEN Ye(Department of Gastroenterology,Nanfang Hospital,Southern Medical University/Guangdong Provincial South Institute of Digestive Diseases,Guangzhou,Guangdong 510515,China)

机构地区：[1]南方医科大学南方医院消化内科/广东省南方消化疾病研究所,广州510515

出　　处：《重庆医学》2021年第14期2380-2383,2388,共5页Chongqing medicine

基　　金：国家自然科学基金项目(81700461,81770529)。

摘　　要：目的寻找快速有效的非新鲜腹泻粪便样本艰难梭菌检测方法。方法收集2014年2月至2019年2月南方医科大学南方医院临床成人新鲜腹泻粪便标本200例,加保存液后冻存1年以上。解冻后4℃静置24 h,然后分别采用细胞毒性实验、毒素酶免疫测定和GX-XVI检测艰难梭菌,了解3种检测技术的阳性率及一致性吻合情况,并评估毒素酶免疫测定和GX-XVI检测灵敏度、特异度等稳定性及可靠性指标,以及约登指数,阳性似然比及阴性似然比等技术筛查指标,探讨其临床应用可能性及优势。结果细胞毒性实验提示非新鲜粪便样本艰难梭菌毒素阳性68例,与新鲜粪便标本培养鉴定结果无差异(68 vs.70)。GX-XVI检测非新鲜腹泻粪便样本阳性率较细胞毒性实验无差异(32.5%vs.34.0%)。酶免疫测定检测非新鲜腹泻粪便样本特异度高(97.0%),但灵敏度低(76.5%),与细胞毒性实验吻合度差。结论GX-XVI可快速有效检测非新鲜腹泻粪便样本艰难梭菌。Objective To find a rapid and effective method for detecting Clostridium difficile in non-fresh diarrhea stool samples.Methods Two hundreds samples of fresh diarrhea feces were collected from clinical adults in Nanfang Hospital from February 2014 to February 2019,and stored frozen for more than 1 year after adding preservation solution.The samples were stood at 4℃for 24 h after thawing,then the cytotoxicity experiment,toxin enzyme immunoassay and GX-XVI were adopted to detect Clostridium difficile.The positive rates of three kinds of detection technology and the consistency anastomosis were understood.The stability and reliability indexes such as sensitivity and specificity,and the technological screening indexes such as Yoden index,positive likelihood ratio and negative likelihood ratio of the toxozyme immunoassay and GX-XVI assay were evaluated.Their clinical application possibilities and advantages were invetigated.Results The cytotoxicity test indicated that 68 non-fresh stool samples were positive for Clostridium difficile toxin,and there was no difference from the results of culture and identification of fresh stool samples(68 vs.70).There was no difference in the positive rate of non-fresh diarrhea fecal samples between the GX-XVI assay and the cytotoxicity test(32.5%vs.34.0%).The enzyme immunoassay showed high specificity(97.0%),but low sensitivity(76.5%)in non-fresh diarrhea fecal samples,and poor coincidence with the cytotoxicity test.Conclusion GX-XVI can rapidly and effectively detect clostridium difficile in non-fresh diarrhea stool samples.

关 键 词：腹泻 粪便 艰难梭菌 毒素 细胞毒性实验 

分 类 号：R574.4[医药卫生—消化系统]