放化疗相关性艰难梭菌相关性腹泻：对放化疗可行性的一个被低估的问题？
Clostridium difficile-associated diarrhea in radiooncology: an underestimated problem for the feasibility of the radiooncological treatment?
机构信息
Department of Radiotherapy, University of Regensburg, Regensburg, Germany.
出版信息
Radiat Oncol. 2011 Aug 1;6:89. doi: 10.1186/1748-717X-6-89.
BACKGROUND AND PURPOSE
Over the last years an increasing incidence of Clostridium difficile-associated diarrhea (CDAD) has been reported. Especially haematology-oncology patients are at risk of developing CDAD.The aim of this analysis is to determine the incidence of CDAD in radiooncological patients and to find out what relevance CDAD has for the feasibility of the radiooncological treatment, as well as to detect and describe risk factors.
PATIENTS AND METHODS
In a retrospective analysis from 2006 to 2010 34 hospitalized radiooncological patients could be identified having CDAD. The risk factors of these patients were registered, the incidence was calculated and the influence on the feasibility of the radiooncological therapy was evaluated. Induced arrangements for prophylaxis of CDAD were identified and have been correlated with the incidence.
RESULTS
The incidence of CDAD in our collective is 1,6%. Most of the patients suffering from a CDAD were treated for carcinoma in the head and neck area. Common risk factors were antibiotics, proton pump inhibitors, cytostatic agents and tube feeding.Beside a high rate of electrolyte imbalance and hypoproteinemia a decrease of general condition was frequent. 12/34 patients had a prolonged hospitalization, in 14/34 patients radiotherapy had to be interrupted due to CDAD. In 21 of 34 patients a concomitant chemotherapy was planned. 4/21 patients could receive all of the planned cycles and only 2/21 patients could receive all of the planned cycles in time.4/34 patients died due to CDAD. In 4/34 patients an initially curative treatment concept has to be changed to a palliative concept.With intensified arrangements for prophylaxis the incidence of CDAD decreased from 4,0% in 2007 to 0,4% in 2010.
CONCLUSION
The effect of CDAD on the feasibility of the radiotherapy and a concomitant chemotherapy is remarkable. The morbidity of patients is severe with a high lethality.Reducing of risk factors, an intense screening and the use of probiotics as prophylaxis can reduce the incidence of CDAD.
背景与目的
近年来，艰难梭菌相关性腹泻（CDAD）的发病率不断上升。特别是血液肿瘤患者存在发生 CDAD 的风险。本分析旨在确定放射肿瘤学患者中 CDAD 的发病率，并确定 CDAD 对放射肿瘤学治疗可行性的相关性，以及发现并描述相关风险因素。
方法
通过回顾性分析，我们从 2006 年至 2010 年期间确定了 34 例患有 CDAD 的住院放射肿瘤学患者。记录这些患者的风险因素，计算发病率，并评估其对放射肿瘤学治疗可行性的影响。确定并分析了预防 CDAD 的诱导措施与发病率的相关性。
结果
我们的研究中 CDAD 的发病率为 1.6%。大多数患有 CDAD 的患者正在接受头颈部癌的治疗。常见的风险因素包括抗生素、质子泵抑制剂、细胞毒性药物和管饲。除了电解质失衡和低蛋白血症发生率较高外，一般情况恶化也很常见。34 例患者中有 12 例住院时间延长，14 例患者因 CDAD 而中断放射治疗。在 34 例患者中有 21 例计划进行联合化疗。在 21 例患者中，4 例能够接受所有计划的化疗周期，只有 2 例能够按时完成所有计划的化疗周期。由于 CDAD，有 4 例患者死亡。在 4 例患者中，最初的治愈性治疗方案需要改为姑息性治疗方案。通过强化预防措施，CDAD 的发病率从 2007 年的 4.0%降至 2010 年的 0.4%。
结论
CDAD 对放射治疗和联合化疗的可行性有显著影响。患者的发病率较高，病情严重，死亡率高。减少风险因素、加强筛查以及使用益生菌作为预防措施可以降低 CDAD 的发病率。
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