罗马ⅲ标准诊断的肠易激综合征患者中无致病性难辨梭状芽孢杆菌感染

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1、罗马Ⅲ标准诊断的肠易激综合征患者中无致病性难辨梭状芽孢杆菌感染?l60?ChinJGastmenterol,2010,Vo1.15,No.3罗马Ⅲ标准诊断的肠易激综合征患者中无致病性难辨梭状芽孢杆菌感染术钟岚徐文王炜熊伍军刘雁冰袁琼英同济大学医学院附属东方医院消化内科(200120)背景:近年来难辨梭状芽孢杆菌(C.difficile)感染率上升.一些轻症Cdifficile感染者症状酷似腹泻型或混合型肠易激综合征(IBS.D或IBS.M).但以一般方法难以检测cdifficile.目的:评估临床上根据罗马Ⅲ标准诊断为IBS.D或IBS—M的病例中

2、是否有一部分与致病性C.difficile现症感染或携带C.d~fficile有关.方法:连续纳入符合IBS罗马Ⅲ诊断标准的120例IBS—D或IBS.M患者,应用VIDAS~c'diffici~A毒素lI(CDA2)试剂盒,以酶联荧光测定(ELFA)技术检测粪便样品中的C.difficile毒素A,如结果可疑,则进一步行CDA2阻抑(CDB)测试以提高分辨率.结果:120例IBS—D和IBS—M患者粪便滤液中均未检测到Cdifficile毒素A.结论:本组根据罗马Ⅲ标准诊断的IBS.D和IBS.M患者无致病性difficile现症感染或携带dif

3、ficile,无证据支持这部分患者需常规使用甲硝唑等抗生素.关键词肠易激综合征;腹泻;梭菌,难辨;感染;罗马Ⅲ标准NoPathogenicClostridiumdifficileInfectionlsFoundinIrritableBowelSyndromePatientsFulfillingRomellICriteriaZHONGLan,XUWen,WANGWei,XIONGWujun,LIUYanbing,YUANQiongying.DepartmentofGastroenterology,EastHospital,TongfiUniversi

4、tySchoolofMedicine,Shanghai(200120)Background:TheinfectionrateofClostridiumdif%ilef￡diJficile)isincreasinginrecentyears,andtheclinicalpresentationofsomepatientswithmildC.difficileinfectionissimilartodiarrhea—predominantandmixedtypeirritablebowelsyndrome(ms.DandIBS—M1.However.i

5、tisreallydifficulttodetectedifficileinfectionbytheusualmethods.Aims-,ToassesswhetheraDorti0noftheIBS—DandIBS—MpatientsfulfillingtheRome11IcriteriaisrelatedtopathogenicCdifficileinfectionorC.difficilecarryingstate.Methods:OnehundredandtwentyconsecutivepatientsfulfillingtheRomeI

6、IIcriteriaforIBS—DandIBS—Mwereprospectivelyenrolledinthisstudy.Stoo】sampleswerecollectedandtestedbyVIDAS0c.difficiletoxinA11(CDA2)kitwithenzyme—linkedfluorescentassay(ELFA)fortoxinA.SampleswithasuspiciousresultwerefurthertestedwithCDA2blocking(CDB)assaytoimprovethedetectionrat

7、e.Results:NoneoftheIBS-DandIBS-MpatientswaspositiveforstoolC.difficiletoxinA.Conclusions:IBS—DandIBS—MpatientsfulfillingtheRomeHIcriteriahavenopathogeniccdifficileinfectionorcarryingofCdifficileinthisstudy.Inthesepatients.routineuseofmetronidazoleorotherantibioticsiSnotrecomme

8、nded.KeywordsIrritableBowelSyndrome;Diarrhea;Clostridiumdcile