摘要
目的恶性肿瘤患者腹泻发生率较高,艰难梭菌感染为其中一个重要的原因,但临床辨别相对困难。本研究拟探讨恶性肿瘤患者艰难梭菌感染相关性腹泻的临床特征。方法回顾性分析472例恶性肿瘤合并腹泻患者,根据患者是否感染艰难梭菌分为艰难梭菌感染阳性组(A组,95例)和艰难梭菌感染阴性组(B组,377例)。采用进行聚合酶链式反应(PCR)检测艰难梭菌毒素A(tcd A)和艰难梭菌毒素B(tcd B);采用倾向值匹配法对研究中非研究混杂因素进行类似随机化的均衡处理。卡钳值设定为0.1,2组按照1∶1的比例进行匹配。记录2组患者一般情况和恶性肿瘤治疗情况等。结果 2组患者倾向值匹配完成后,每组共有91例患者纳入研究。A组患者与B组患者一般资料差异均无统计学意义(均P>0.05);A组患者血浆白蛋白水平明显低于B组(P<0.01),抗生素应用比例、质子泵抑制剂应用比例化疗、便潜血阳性比例和化疗后体能状态(ECOG)评分明显高于B组(均P<0.05);2组患者不良反应发生情况差异无统计学意义(P>0.05)。结论恶性肿瘤艰难梭菌感染相关性腹泻患者血浆白蛋白水平下降、便潜血阳性增加。抗生素、化疗和质子泵抑制剂的使用可能会增加恶性肿瘤患者艰难梭菌感染几率。
Objective The incidence rate of diarrhea in patients with malignant tumor is high. The Clostridium difficile infection is an important cause. However, it is difficult to distinguish clinically. This study intended to investigate the clinical characteristics for Clostridium difficile-associated diarrhea among cancer patients in China. Methods We inves- tigated the prospective clinical database for cancer patients combined with diarrhea, and a total of 472 patients included in this study, who were divided into 2 groups depending on whether or not Clostridium difficile infection ： Clostridium dif- ficile infection group （Group A, n = 95 ） and Non-Clostridium difficile infection group （Group B, n = 377 ）. Polymerase chain reaction （PCR） was used to detect the Clostridium difficile poisonA （tcdA） and Clostridium difficile poison B （tc- dB ）. The patient general information was recorded, blood routine examination and biochemical test were performed. The ECOG score was recorded before chemotherapy and during diarrhea. The side effects, chemoradiotherapy, proton pump inhibitor and antibiotic therapy within 4 weeks before diarrhea, the time of antibiotic therapy were also recorded. Propen- sity score matching analysis with preset caliper width 0.1 was used to keep the equilibrium in general information between groups, and the two groups were matched with 1： 1. The general information and malignant tumor treatment information of the patients were recorded. Results A total of 91 matched pairs were selected from the patients after the propensity score matching analysis, and no difference was found in general information between Group A and Group B （P 〉 0.05 ）. Compared with Group B, the level of plasma albumin decreased in Group A （P 〈 0.01 ） , the proportion of antibiotic ap- plication, proton pump inhibitor, positive fecal occult blood test and ECOG score after chemotherapy were increased in Group A （P 〈 0.05 or P 〈 0.01 ）. No difference was found in side effects between two groups. Conclusion The level of plasma albumin decreased and the incidence of positive fecal occult blood test increased in patients with malignant tumor associated diarrhea of Clostridium difficile infection. The use of antibiotics, chemotherapy and proton pump inhibitors may increase the risk of Clostridium difficile infection in patients with malignant tumors.
作者
金利民
沈宇泓
曹晨曦
阮玲娟
衡翔
邵平扬
陈松劲
JIN Li-min;SHEN Yu-hong;CAO Chen-xi(Department of Laboratory, the Second Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang 314000, China)
出处
《中华全科医学》
2018年第5期820-822,834,共4页
Chinese Journal of General Practice
基金
浙江省卫生和计划生育委员会科研基金项目(2014KYA211)
关键词
恶性肿瘤
艰难梭菌
感染
临床特征
Malignant tumor
Clostridium Difficile
Infection
Clinical features
