儿童炎症性肠病艰难梭菌感染及其易感因素分析

Clostridium difficile infection and its susceptibility factors in children with inflammatory bowel disease

摘要:

目的 了解儿童炎症性肠病（inflammatory bowel disease，IBD）中艰难梭菌定植及感染的发生率，评估儿童IBD患者发生艰难梭菌感染（Clostridium difficile infection，CDI）的易感因素。方法 选取62例确诊IBD患儿为IBD组，选择同期因迁延性或慢性腹泻就诊并排除IBD的儿童42例为非IBD组，比较两组CDI情况；根据是否合并CDI将IBD组分为IBD合并CDI组（n=12）和IBD无CDI组（n=50），收集两组患儿相关临床资料行CDI易感因素分析。结果 IBD组CDI发生率为19%（12/62），高于非IBD组（2%，1/42）（P < 0.05）。IBD合并CDI组病程长于IBD无CDI组（P < 0.05），发热、腹泻、腹痛比例高于IBD无CDI组（P < 0.05）。IBD合并CDI组儿童克罗恩病活动指数、C反应蛋白、红细胞沉降率高于IBD无CDI组（P < 0.05）。单因素分析显示，IBD合并CDI组疾病严重程度（中重度）、使用激素、诊断前接受广谱抗生素治疗14 d以上比例高于IBD无CDI组（P < 0.05）。结论 IBD患儿CDI发生率较非IBD儿童高。病情越严重、使用广谱抗生素及激素可能导致IBD患儿更易发生CDI。

Abstract:

Objective To investigate the incidence rates of Clostridium difficile colonization and Clostridium difficile infection (CDI) in children with inflammatory bowel disease (IBD) and the susceptibility factors for CDI in children with IBD. Methods A total of 62 children diagnosed with IBD were enrolled as the IBD group. Forty-two children who attended the hospital due to persistent or chronic diarrhea and were excluded from IBD were enrolled as the non-IBD group. The incidence rate of CDI was compared between the two groups. According to the presence or absence of CDI, the IBD group was subdivided into two groups:IBD+CDI (n=12) and non-CDI IBD (n=50), and the clinical data were collected from the two groups to analyze the susceptibility factors for CDI. Results The IBD group had a significantly higher incidence rate of CDI[19% (12/62) vs 2% (1/42); P < 0.05] than the non-IBD group (P < 0.05). Compared with the non-CDI IBD group, the IBD+CDI group had a significantly longer disease course (P < 0.05), and a significantly higher proportion of children with fever, diarrhea, or abdominal pain (P < 0.05). The IBD+CDI group had significantly higher activity indices of pediatric Crohn's disease, C-reactive protein levels and erythrocyte sedimentation rate than the non-CDI IBD group (P < 0.05). The univariate analysis showed that compared with the non-CDI IBD group, the IBD+CDI group had a significantly higher proportion of children with moderate-to-severe disease, use of glucocorticoids, or treatment with broad-spectrum antibiotics for more than 14 days before diagnosis (P < 0.05). Conclusions The children with IBD have a higher incidence of CDI than those without IBD. Severe disease conditions and use of broad-spectrum antibiotics or glucocorticoids may be associated with an increased incidence of CDI in children with IBD.