Kyne L, Warny M, Qamar A, Kelly C P
Gerontology Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA.
Lancet. 2001 Jan 20;357(9251):189-93. doi: 10.1016/S0140-6736(00)03592-3.
We have reported that symptom-free carriers of Clostridium difficile have a systemic anamnestic immune response to toxin A. The aim of this study was to determine whether an acquired immune response to toxin A, during an episode of C. difficile diarrhoea, influences risk of recurrence.
We prospectively studied 63 patients with nosocomial C. difficile diarrhoea. Serial serum IgA, IgG, and IgM concentrations against C. difficile toxin A, toxin B, or non-toxin antigens were measured by ELISA. Individuals were followed for 60 days.
19 patients died (30%). Of the 44 who survived, 22 had recurrent C. difficile diarrhoea. Patients with a single episode of C. difficile diarrhoea (n=22) had higher concentrations of serum IgM against toxin A on day 3 of their first episode of diarrhoea than those with recurrent diarrhoea (n=22, p=0.004). On day 12, serum IgG values against toxin A were higher in patients who had a single episode of diarrhoea (n=7) than in those who subsequently had recurrent diarrhoea (n=9, p=0.009). The odds ratio for recurrence associated with a low concentration of serum IgG against toxin A, measured 12 days after onset of C. difficile diarrhoea, was 48.0 (95% CI 3.5-663).
A serum antibody response to toxin A, during an initial episode of C. difficile diarrhoea, is associated with protection against recurrence.
我们曾报道艰难梭菌无症状携带者对毒素A有全身性回忆性免疫反应。本研究的目的是确定在艰难梭菌腹泻发作期间，对毒素A的获得性免疫反应是否会影响复发风险。
我们前瞻性地研究了63例医院获得性艰难梭菌腹泻患者。通过酶联免疫吸附测定法（ELISA）检测针对艰难梭菌毒素A、毒素B或非毒素抗原的系列血清IgA、IgG和IgM浓度。对个体进行了60天的随访。
19例患者死亡（30%）。在44例存活患者中，22例出现艰难梭菌腹泻复发。初次发生艰难梭菌腹泻的患者（n = 22）在首次腹泻发作第3天时，其针对毒素A的血清IgM浓度高于复发腹泻患者（n = 22，p = 0.004）。在第12天时，初次发生腹泻的患者（n = 7）针对毒素A的血清IgG值高于随后复发腹泻的患者（n = 9，p = 0.009）。艰难梭菌腹泻发作12天后，血清中针对毒素A的IgG浓度较低与复发相关的比值比为48.0（95%可信区间3.5 - 663）。
在初次艰难梭菌腹泻发作期间，针对毒素A的血清抗体反应与预防复发有关。
