难辨梭状芽孢杆菌感染检测与病因学初探

发布时间：2018-04-03 15:29

  本文选题：难辨梭状芽孢杆菌　切入点：艰难梭菌感染　出处：《上海交通大学》2015年硕士论文

【摘要】：研究目的:国内艰难梭菌感染(Clostridium difficile infection)检测及监控仍处于起步阶段。本文通过比较不同方法学检测院内艰难梭菌感染分析以及通过社区获得性艰难梭菌感染与抑酸治疗之间关系的荟萃研究,探索艰难梭菌感染的检测方法以及临床病因学联系,及时指导临床识别艰难梭菌感染,预防和控制社区和公共医疗机构的艰难梭菌感染的发生。研究方法:对上海市仁济医院2014.9-2015.3腹泻患者的粪便标本通过艰难梭菌毒素A/B酶联荧光免疫分析(ELFIA)检测和艰难梭菌培养基分离鉴定菌株及毒素,并通过PCR验证两种不同方法比较检测结果。1.使用系统性文献搜索方法搜索如下电子数据库:Pubmed,Web of Knowledge和EMBASE数据库。纳入时间为发布时间为2014年12月前的能获取摘要或全文的研究。根据纳入和排除标准入选7篇研究进行荟萃分析研究抑酸药物与社区获得性艰难梭菌感染之间的联系。研究结果:1.293例患者中ELFIA法毒素检出共29例(9.9%)。其中小于35岁共8例(27.5%),35 65岁共14例(48.3%,OR 1.46 95%CI 0.59 3.62),大于65岁共7例(24.2%,OR 2.08 95%CI 0.71 6.08),女性19例(65.6%,OR 4.0,95%CI1.79 8.98)。138例患者中艰难梭菌培养共检出21例(15.2%)。其中小于35岁共8例(38.1%),35 65岁共12例(57.1%,OR 1.29 95%CI 0.48 3.44),大于65岁共1例(4.8%,OR 0.20 95%CI 0.02 1.71),女性12例(57.1%,OR 2.77,95%CI 1.08 7.15);2.26株艰难梭菌临床分离株的毒素A/B进行PCR扩增,其中TcdA(+)/TcdB(+)共7株,TcdA(-)/TcdB(+)共18株,TcdA(-)/TcdB(-)共1株。其中粪便毒素检测阳性的15株分离株中100%检测出TcdA及TcdB基因,而在10株粪便毒素检测阴性的分离株中仅1株未检测到TcdA和TcdB基因;3.通过共计7篇文章包含110712名患者,组胺H2受体拮抗剂患者相较未使用者发生艰难梭菌感染的OR值为1.76(95%CI 1.45,2.14,P0.00001,I2=0),使用质子泵抑制患者相较未使用者发生艰难梭菌感染的OR值为2.08(95%CI 1.50,2.90,P0.0001,I2=79)。研究结论:艰难梭菌培养的结果阳性率显著高于艰难梭菌毒素A/B酶联荧光免疫分析(ELFIA)。艰难梭菌毒素检测阳性的比值比与女性患者及年龄的增高有相关性;艰难梭菌毒素A/B酶联荧光免疫分析(ELFIA)检测特异性高,但敏感性较艰难梭菌培养欠佳。通过合并研究分析提示使用抑酸治疗(PPI or H2RA)均增加约2倍的艰难梭菌感染风险。此结果提示抑酸药物使用可能是艰难梭菌感染中重要的诱因之一。临床使用抑酸药物时应充分权衡利弊使用。
[Abstract]:Objective: the detection and monitoring of Clostridium difficile infection in China is still in its infancy.By comparing the analysis of different methods for the detection of Clostridium diffracta infection in hospital and the meta-study on the relationship between community-acquired Clostridium dysuria infection and acid suppression therapy, we explored the detection methods of Clostridium diffracta infection and the relationship between clinical etiology and clinical etiology.Timely guide clinical identification of Clostridium diffracta infection, prevention and control of community and public medical institutions.Methods: fecal specimens of diarrhea patients from Shanghai Renji Hospital from April to March 2014.were detected by Clostridium difficult toxin A / B enzyme linked fluorescence immunoassay (Elisa) and isolated and identified in the culture medium of Clostridium diffracta.The results of two different methods were compared with each other by PCR.A systematic literature search method was used to search the following electronic databases: Knowledge of Knowledge and EMBASE.Inclusion time for available abstracts or full text studies before December 2014.Seven studies were selected according to inclusion and exclusion criteria to study the relationship between acid-suppressants and community-acquired Clostridium difficulty infection.Results among 1.293 patients, 29 cases were detected by ELFIA method.鍏朵腑灏忎簬35宀佸叡8渚，

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