本文選題：難辨梭狀芽孢桿菌　切入點(diǎn)：艱難梭菌感染　出處：《上海交通大學(xué)》2015年碩士論文

【摘要】：研究目的:國內(nèi)艱難梭菌感染(Clostridium difficile infection)檢測(cè)及監(jiān)控仍處于起步階段。本文通過比較不同方法學(xué)檢測(cè)院內(nèi)艱難梭菌感染分析以及通過社區(qū)獲得性艱難梭菌感染與抑酸治療之間關(guān)系的薈萃研究,探索艱難梭菌感染的檢測(cè)方法以及臨床病因?qū)W聯(lián)系,及時(shí)指導(dǎo)臨床識(shí)別艱難梭菌感染,預(yù)防和控制社區(qū)和公共醫(yī)療機(jī)構(gòu)的艱難梭菌感染的發(fā)生。研究方法:對(duì)上海市仁濟(jì)醫(yī)院2014.9-2015.3腹瀉患者的糞便標(biāo)本通過艱難梭菌毒素A/B酶聯(lián)熒光免疫分析(ELFIA)檢測(cè)和艱難梭菌培養(yǎng)基分離鑒定菌株及毒素,并通過PCR驗(yàn)證兩種不同方法比較檢測(cè)結(jié)果。1.使用系統(tǒng)性文獻(xiàn)搜索方法搜索如下電子數(shù)據(jù)庫:Pubmed,Web of Knowledge和EMBASE數(shù)據(jù)庫。納入時(shí)間為發(fā)布時(shí)間為2014年12月前的能獲取摘要或全文的研究。根據(jù)納入和排除標(biāo)準(zhǔn)入選7篇研究進(jìn)行薈萃分析研究抑酸藥物與社區(qū)獲得性艱難梭菌感染之間的聯(lián)系。研究結(jié)果:1.293例患者中ELFIA法毒素檢出共29例(9.9%)。其中小于35歲共8例(27.5%),35 65歲共14例(48.3%,OR 1.46 95%CI 0.59 3.62),大于65歲共7例(24.2%,OR 2.08 95%CI 0.71 6.08),女性19例(65.6%,OR 4.0,95%CI1.79 8.98)。138例患者中艱難梭菌培養(yǎng)共檢出21例(15.2%)。其中小于35歲共8例(38.1%),35 65歲共12例(57.1%,OR 1.29 95%CI 0.48 3.44),大于65歲共1例(4.8%,OR 0.20 95%CI 0.02 1.71),女性12例(57.1%,OR 2.77,95%CI 1.08 7.15);2.26株艱難梭菌臨床分離株的毒素A/B進(jìn)行PCR擴(kuò)增,其中TcdA(+)/TcdB(+)共7株,TcdA(-)/TcdB(+)共18株,TcdA(-)/TcdB(-)共1株。其中糞便毒素檢測(cè)陽性的15株分離株中100%檢測(cè)出TcdA及TcdB基因,而在10株糞便毒素檢測(cè)陰性的分離株中僅1株未檢測(cè)到TcdA和TcdB基因;3.通過共計(jì)7篇文章包含110712名患者,組胺H2受體拮抗劑患者相較未使用者發(fā)生艱難梭菌感染的OR值為1.76(95%CI 1.45,2.14,P0.00001,I2=0),使用質(zhì)子泵抑制患者相較未使用者發(fā)生艱難梭菌感染的OR值為2.08(95%CI 1.50,2.90,P0.0001,I2=79)。研究結(jié)論:艱難梭菌培養(yǎng)的結(jié)果陽性率顯著高于艱難梭菌毒素A/B酶聯(lián)熒光免疫分析(ELFIA)。艱難梭菌毒素檢測(cè)陽性的比值比與女性患者及年齡的增高有相關(guān)性;艱難梭菌毒素A/B酶聯(lián)熒光免疫分析(ELFIA)檢測(cè)特異性高,但敏感性較艱難梭菌培養(yǎng)欠佳。通過合并研究分析提示使用抑酸治療(PPI or H2RA)均增加約2倍的艱難梭菌感染風(fēng)險(xiǎn)。此結(jié)果提示抑酸藥物使用可能是艱難梭菌感染中重要的誘因之一。臨床使用抑酸藥物時(shí)應(yīng)充分權(quán)衡利弊使用。
[Abstract]:Objective: the detection and monitoring of Clostridium difficile infection in China is still in its infancy.By comparing the analysis of different methods for the detection of Clostridium diffracta infection in hospital and the meta-study on the relationship between community-acquired Clostridium dysuria infection and acid suppression therapy, we explored the detection methods of Clostridium diffracta infection and the relationship between clinical etiology and clinical etiology.Timely guide clinical identification of Clostridium diffracta infection, prevention and control of community and public medical institutions.Methods: fecal specimens of diarrhea patients from Shanghai Renji Hospital from April to March 2014.were detected by Clostridium difficult toxin A / B enzyme linked fluorescence immunoassay (Elisa) and isolated and identified in the culture medium of Clostridium diffracta.The results of two different methods were compared with each other by PCR.A systematic literature search method was used to search the following electronic databases: Knowledge of Knowledge and EMBASE.Inclusion time for available abstracts or full text studies before December 2014.Seven studies were selected according to inclusion and exclusion criteria to study the relationship between acid-suppressants and community-acquired Clostridium difficulty infection.Results among 1.293 patients, 29 cases were detected by ELFIA method.鍏朵腑灝忎簬35宀佸叡8渚，

本文編號(hào)：1705796