Kelly C P
Beth Israel Hospital, Harvard Medical Schoo, Boston, MA, USA.
Eur J Gastroenterol Hepatol. 1996 Nov;8(11):1048-53. doi: 10.1097/00042737-199611000-00004.
Clostridium difficile produces two toxins (A and B) which cause antibiotic-associated diarrhoea and pseudomembranous colitis. One of the most puzzling aspects of C. difficile infection is the wide spectrum of clinical presentation which ranges from asymptomatic carriage to fulminant, life-threatening colitis. This review examines the hypothesis that immune responses to C. difficile underlie these dramatic variations in disease presentation and course. Animals can be protected from C. difficile colitis by passive or active immunization against toxins A and B. Human antibody responses to these toxins are evident in approximately 60% of the general population. A number of clinical studies indicate that antitoxin responses in both serum and intestinal secretions may be protective whereas an inadequate immune response predisposes to severe or recurrent C. difficile diarrhoea. Thus there is now considerable interest in developing methods for passive and active immunization to combat this prevalent nosocomial intestinal pathogen.
艰难梭菌产生两种毒素（A和B），可导致抗生素相关性腹泻和假膜性结肠炎。艰难梭菌感染最令人困惑的方面之一是临床表现范围广泛，从无症状携带到暴发性、危及生命的结肠炎。这篇综述探讨了一种假说，即针对艰难梭菌的免疫反应是疾病表现和病程中这些显著差异的基础。通过对毒素A和B进行被动或主动免疫，可以保护动物免受艰难梭菌结肠炎的侵害。在大约60%的普通人群中，人体对这些毒素的抗体反应是明显的。多项临床研究表明，血清和肠道分泌物中的抗毒素反应可能具有保护作用，而免疫反应不足则易导致严重或复发性艰难梭菌腹泻。因此，目前人们对开发被动和主动免疫方法以对抗这种常见的医院内肠道病原体有相当大的兴趣。
