Fisher J F, Tedesco F J, Johnson D H, Rissing J P, Walker C A, Trincher R C, Howard L, Buxton T, Agel J F
J Clin Gastroenterol. 1982 Jun;4(3):253-6. doi: 10.1097/00004836-198206000-00010.
Discontinuous counterimmunoelectrophoresis (DCIE) was employed to detect the toxin of Clostridium difficile, etiologic antibiotic-associated colitis (AAC), in bacteria-free stool filtrates from 51 patients with diarrhea. Stool samples from 31 patients contained C. difficile toxin as determined by tissue-culture assay. A positive result was obtained by DCIE in 20 of the 31 patients (65%) and was influenced by the titer of toxin present. When toxin was present by tissue-culture assay in a dilution of less than or equal to 10(-2) (11 samples), DCIE was positive in only 2 (18%). However, DCIE yielded positive results in 18 of the 20 samples (90%) containing toxin titers greater than or equal to 10(-3). The combination of DCIE and sigmoidoscopy of colonoscopy was superior to either alone in the diagnosis of AAC irrespective of the toxin titer. Nine of 11 patients (82%) whose stool samples contained C. difficile toxin in a dilution of less than or equal to 10(-2) were recognized by DCIE, endoscopy, or both. In stool samples containing toxin in titers greater than or equal to 10(-3), no false-negative results were encountered (sensitivity equals 100%). Thus, 29 of 31 patients whose stool samples contained C. difficile toxin were identified when the results of DCIE and endoscopical examination were combined (sensitivity 93.5%). Neither endoscopical examination nor DCIE yielded positive results in the 20 patients whose stool samples lacked C. difficile toxin (specificity equals 100%). DCIE is a rapid, moderately sensitive, and specific method for detecting C. difficile toxin. When DCIE is combined with endoscopy, the vast majority of patients requiring specific therapy for AAC can be identified.
采用间断对流免疫电泳（DCIE）检测51例腹泻患者无菌粪便滤液中艰难梭菌毒素，该菌是抗生素相关性结肠炎（AAC）的病原体。通过组织培养试验确定，31例患者的粪便样本中含有艰难梭菌毒素。31例患者中有20例（65%）DCIE检测结果为阳性，且受毒素滴度影响。当组织培养试验中毒素稀释度小于或等于10⁻²（11份样本）时，DCIE仅2例（18%）呈阳性。然而，在20份毒素滴度大于或等于10⁻³的样本中，DCIE有18例（90%）呈阳性。无论毒素滴度如何，DCIE与乙状结肠镜检查或结肠镜检查相结合在AAC诊断中均优于单独使用其中任何一种方法。11例粪便样本中艰难梭菌毒素稀释度小于或等于10⁻²的患者中有9例（82%）通过DCIE、内镜检查或两者均被确诊。在毒素滴度大于或等于10⁻³的粪便样本中，未出现假阴性结果（敏感性等于100%）。因此，当DCIE和内镜检查结果相结合时，31例粪便样本中含有艰难梭菌毒素的患者中有29例被确诊（敏感性93.5%）。20例粪便样本中缺乏艰难梭菌毒素的患者，内镜检查和DCIE均未得出阳性结果（特异性等于100%）。DCIE是一种检测艰难梭菌毒素的快速、中度敏感且特异的方法。当DCIE与内镜检查相结合时，绝大多数需要针对AAC进行特异性治疗的患者都能被确诊。
