[癌症患者艰难梭菌相关性腹泻的危险因素]
[Risk factors for Clostridium difficile-associated diarrhea among cancer patients].
作者信息
Zhu Yu, Wang Li, Feng Shana, Wang Shuai, Zheng Cuiling, Wang Jingzhi, Du Chunxia, Feng Yun, Li Dan, Shi Yuankai, Han Xiaohong
机构信息
Department of Clinical Laboratory, Cancer Institute and Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.
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出版信息
Zhonghua Zhong Liu Za Zhi. 2014 Oct;36(10):773-7.
OBJECTIVE
The aim of this study was to investigate the prevalence of Clostridium difficile (C. difficile) infection and the risk factors for acquisition of C. difficile-associated diarrhea (CDAD) among cancer patients who received chemotherapy or radiation therapy.
METHODS
We analyzed 277 stool samples from cancer patients with diarrhea between Sep 2010 and Dec 2011 in our hospital. Stool C. difficile toxin A/B test, stool culture for C. difficile and routine stool examination were performed. In addition, the risk factors for CDAD were investigated in a set of 41 C. difficile toxin-positive cancer patients and 82 matched C. difficile toxin-negative controls by univariate analysis and multivariate analysis.
RESULTS
Out of a total of 277 cancer patients with diarrhea, 41 (14.8%) were C. difficile toxin-positive. Among these 41 cases, 11 (26.8%, 11/41) were C. difficile culture-positive. Univariate analysis showed that antibiotics use (P = 0.853), proton pump inhibitor use (P = 0.718), hypoproteinemia (P = 0.139) and white blood cell count (P = 0.454) did not appear to be associated with acquisition of CDAD in cancer patients. However, receiving chemotherapy (P = 0.023), receiving radiotherapy (P = 0.003), a positive fecal occult blood test result (P = 0.005) and the presence of fecal leukocytes (P = 0.007) showed close association with acquisition of CDAD in cancer patients. Multivariate analysis showed that receiving chemotherapy (OR, 8.308; 95% CI, 1.997-34.572; P = 0.004) and a positive result of fecal occult blood test (OR, 8.475; 95% CI, 1.463-49.109; P = 0.017) were independent risk factors for acquisition of CDAD among cancer patients.
CONCLUSIONS
Our results support that receiving chemotherapy and a positive fecal occult blood test result are independent risk factors for acquisition of CDAD among cancer patients. Cancer patients who are at high-risk for CDAD should take stool C. difficile toxin A/B test and stool culture for C. difficile regularly and prevention of CDAD.
目的
本研究旨在调查接受化疗或放疗的癌症患者中艰难梭菌感染的患病率以及获得艰难梭菌相关性腹泻（CDAD）的危险因素。
方法
我们分析了2010年9月至2011年12月期间我院腹泻癌症患者的277份粪便样本。进行了粪便艰难梭菌毒素A/B检测、艰难梭菌粪便培养和常规粪便检查。此外，通过单因素分析和多因素分析，在一组41例艰难梭菌毒素阳性癌症患者和82例匹配的艰难梭菌毒素阴性对照中调查了CDAD的危险因素。
结果
在总共277例腹泻癌症患者中，41例（14.8%）艰难梭菌毒素呈阳性。在这41例病例中，11例（26.8%，11/41）艰难梭菌培养呈阳性。单因素分析显示，抗生素使用（P = 0.853）、质子泵抑制剂使用（P = 0.718）、低蛋白血症（P = 0.139）和白细胞计数（P = 0.454）似乎与癌症患者获得CDAD无关。然而，接受化疗（P = 0.023）、接受放疗（P = 0.003）、粪便潜血试验结果阳性（P = 0.005）和粪便白细胞的存在（P = 0.007）与癌症患者获得CDAD密切相关。多因素分析显示，接受化疗（OR，8.308；95%CI，1.997 - 34.572；P = 0.004）和粪便潜血试验阳性结果（OR，8.475；95%CI，1.463 - 49.109；P = 0.017）是癌症患者获得CDAD的独立危险因素。
结论
我们的结果支持接受化疗和粪便潜血试验阳性结果是癌症患者获得CDAD的独立危险因素。CDAD高危癌症患者应定期进行粪便艰难梭菌毒素A/B检测和艰难梭菌粪便培养，并预防CDAD。
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