艰难梭菌感染与不良结局的炎症性肠病患者的病例对照研究，以及艰难梭菌与巨细胞病毒合并感染患者的研究。
Case-Control Study of Inflammatory Bowel Disease Patients with and without Clostridium difficile Infection and Poor Outcomes in Patients Coinfected with C. difficile and Cytomegalovirus.
机构信息
Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, No. 1 Shuaifuyuan, Dongcheng District, Beijing, 100730, China.
Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, School of Basic Medicine, Peking Union Medical College, Beijing, China.
出版信息
Dig Dis Sci. 2018 Nov;63(11):3074-3083. doi: 10.1007/s10620-018-5230-1. Epub 2018 Aug 9.
BACKGROUND AND AIMS
Clostridium difficile infection (CDI) incidence and risk factors in patients with inflammatory bowel disease (IBD) have been extensively studied. However, data describing CDI in Chinese patients with IBD are limited. We investigated the cumulative incidence, risk factors, and outcomes of CDI in Chinese IBD patients.
METHODS
We conducted a retrospective, case-control study of patients hospitalized with IBD and CDI at Peking Union Medical College Hospital from January 2010 to December 2015. CDI was diagnosed based on the presence of active symptoms and positive enzyme immunoassay-based stool test results for C. difficile toxin A or B (CDAB). Controls were selected from CDAB-negative patients with IBD and matched by age, gender, phenotypes of IBD and the same time period of CDAB testing at a 1:2 or 1:3 ratio.
RESULTS
We identified 60 (7.41%) cases of CDI among 810 patients with IBD, and 137 control cases were selected. Univariate analysis revealed that IBD patients with CDI had higher rates of concurrent corticosteroid use, proton pump inhibitor, antibiotic use, recent hospitalization, parenteral nutrition support, and cytomegalovirus (CMV) coinfection (P < 0.05). Multivariate analysis revealed that concurrent corticosteroid use (odds ratio [OR] = 6.803, 95% confidence interval [CI] = 2.901-15.954, P < 0.001) and hospitalization within 1 month (OR = 3.028, 95% CI = 1.225-7.480, P = 0.016) were associated with CDI. CMV and C. difficile coinfection (hazard ratio [HR] = 4.185, 95% CI = 1.492-11.736, P = 0.007) as well as disease severity (HR 2.070, 95% CI = 1.006-4.261, P = 0.048) were independently associated with colectomy following CDI.
CONCLUSIONS
IBD patients with concurrent corticosteroid use and recent hospitalization are at a higher risk of CDI. CMV and C. difficile coinfection is associated with poorer outcomes.
背景与目的
艰难梭菌感染（CDI）在炎症性肠病（IBD）患者中的发病率和危险因素已得到广泛研究。然而，描述中国 IBD 患者中 CDI 的数据有限。我们调查了中国 IBD 患者中 CDI 的累积发病率、危险因素和结局。
方法
我们对 2010 年 1 月至 2015 年 12 月在北京协和医院住院的 IBD 合并 CDI 患者进行了回顾性病例对照研究。CDI 的诊断依据为存在活跃症状和阳性酶联免疫吸附试验检测艰难梭菌毒素 A 或 B（CDAB）。对照病例从 CDAB 阴性的 IBD 患者中选择，按年龄、性别、IBD 表型和相同的 CDAB 检测时间以 1:2 或 1:3 的比例匹配。
结果
我们在 810 例 IBD 患者中发现 60 例（7.41%）CDI，选择了 137 例对照病例。单因素分析显示，合并 CDI 的 IBD 患者中皮质类固醇、质子泵抑制剂、抗生素、近期住院、肠外营养支持和巨细胞病毒（CMV）合并感染的发生率更高（P<0.05）。多因素分析显示，皮质类固醇（比值比[OR] = 6.803，95%置信区间[CI] = 2.901-15.954，P<0.001）和 1 个月内住院（OR = 3.028，95%CI = 1.225-7.480，P = 0.016）与 CDI 相关。CMV 和艰难梭菌合并感染（风险比[HR] = 4.185，95%CI = 1.492-11.736，P = 0.007）以及疾病严重程度（HR 2.070，95%CI = 1.006-4.261，P = 0.048）与 CDI 后结肠切除术独立相关。
结论
合并皮质类固醇和近期住院的 IBD 患者 CDI 风险较高。CMV 和艰难梭菌合并感染与预后较差相关。
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