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目的比较细菌培养法、酶联荧光免疫分析技术(ELFIA)检测艰难梭菌毒素A/B、PCR检测肠毒素(tcd)A/B对恶性肿瘤化疗期腹泻患者的艰难梭菌检出率,并分析艰难梭菌感染患者的临床特征。方法选择212例行恶性肿瘤化疗的腹泻患者为研究对象,分别采用粪便艰难梭菌培养、ELFIA检测艰难梭菌毒素A/B、PCR检测tcd A/B等3种方法,比较其艰难梭菌阳性检出率,并分析艰难梭菌感染患者的临床特征。结果粪便艰难梭菌培养、ELFIA检测艰难梭菌毒素A/B、PCR检测tcd A/B的阳性检出率分别为12.7%、10.4%和31.6%;PCR的阳性检出率明显高于其他2种方法(均P<0.05)。PCR检测艰难梭菌阳性的67例患者中男36例,女31例;年龄46~89(67.2±10.8)岁;合并心血管疾病或糖尿病等基础性疾病占86.6%;所有患者使用过广谱抗生素、质子泵抑制剂(PPIs);粪便潜血试验阳性占95.5%;平均血浆白蛋白浓度为37.92g/L,C反应蛋白为30.25mg/L。结论 PCR的阳性检出率最高。恶性肿瘤化疗患者若年龄较高、使用过广谱抗生素或PPIs和粪便潜血试验阳性合并腹泻时,应考虑艰难梭菌感染。
Objective To compare the detection rate of Clostridium difficile toxin A / B by enzyme-linked immunosorbent assay (ELFIA) and PCR detection of toxin (tcd) A / B against C. difficile in patients with diarrhea during chemotherapy Clinical characteristics of patients infected with Clostridium difficile were analyzed. Methods A total of 212 patients with diarrhea undergoing chemotherapy for malignant tumor were selected as study subjects. The C. difficile stool culture, ELFIA detection of C. difficile toxin A / B, PCR detection of tcd A / B and so on were compared. Detection rate, and analysis of clinical characteristics of patients infected with Clostridium difficile. Results Clostridium difficile was cultured. The detection rate of C. difficile toxin A / B by ELFIA was 12.7%, 10.4% and 31.6% respectively. The positive rate of PCR was significantly higher than that of other two Methods (all P <0.05). PCR-based detection of C. difficile positive 67 patients, 36 males and 31 females; aged 46 to 89 (67.2 ± 10.8) years old; combined with cardiovascular disease or diabetes and other basic diseases accounted for 86.6%; all patients used a broad spectrum Antibiotics, proton pump inhibitors (PPIs); stool occult blood test positive accounted for 95.5%; average plasma albumin concentration was 37.92g / L, C-reactive protein was 30.25mg / L. Conclusion The positive rate of PCR was the highest. Chemotherapy with malignant tumors should be considered for Clostridium difficile infections if they are older, have used broad-spectrum antibiotics or PPIs, and fecal occult blood test positive for diarrhea.