质子泵抑制剂作为艰难梭菌相关性腹泻复发的危险因素。
Proton pump inhibitors as a risk factor for recurrence of Clostridium-difficile-associated diarrhea.
机构信息
Division of Gastroenterology and Hepatology, Department of Internal Medicine, Seoul National University Boramae Hospital, Seoul National University College of Medicine, Seoul 156-707, South Korea.
出版信息
World J Gastroenterol. 2010 Jul 28;16(28):3573-7. doi: 10.3748/wjg.v16.i28.3573.
AIM
To investigate the risk factors for Clostridium-difficile-associated diarrhea (CDAD) recurrence, and its relationship with proton pump inhibitors (PPIs).
METHODS
Retrospective data of 125 consecutive hospitalized patients diagnosed with CDAD between January 2006 and December 2007 were collected by medical chart review. Collected data included patient characteristics at baseline, underlying medical disease, antibiotic history before receiving a diagnosis of CDAD, duration of hospital stay, severity of CDAD, concurrent treatment with PPIs, laboratory parameters, response to CDAD therapy, and recurrence of disease within 90 d of successful treatment. Various clinical and laboratory parameters were compared in patients in whom CDAD did or did not recur.
RESULTS
Of the 125 patients (mean age, 67.6 +/- 13.9 years) that developed CDAD, 98 (78.4%) did not experience recurrence (non-recurrent group) and 27 (21.6%) experienced one or more recurrences (recurrent group). Prior to the development of CDAD, 96% of the 125 patients were prescribed antibiotics, and 56 (44.8%) of the patients received PPIs. Age older than 65 years (P = 0.021), feeding via nasogastric tube (NGT) (P = 0.045), low serum albumin level (P = 0.025), and concurrent use of PPIs (P = 0.014) were found to be risk factors for CDAD recurrence by univariate analysis. However, sex, length of hospital stay, duration and type of antibiotics used, severity of disease, leukocyte count and C-reactive protein (CRP) were not associated with risk of CDAD recurrence. On multivariate analysis, the important risk factors were advanced age (> 65 years, adjusted OR: 1.32, 95% CI: 1.12-3.87, P = 0.031), low serum albumin level (< 2.5 g/dL, adjusted OR: 1.85, 95% CI: 1.35-4.91, P = 0.028), and concurrent use of PPIs (adjusted OR: 3.48, 95% CI: 1.64-7.69, P = 0.016).
CONCLUSION
Advanced age, serum albumin level < 2.5 g/dL, and concomitant use of PPIs were found to be significant risk factors for CDAD recurrence.
目的
探讨艰难梭状芽孢杆菌相关性腹泻（CDAD）复发的危险因素及其与质子泵抑制剂（PPIs）的关系。
方法
通过病历回顾，收集了 2006 年 1 月至 2007 年 12 月期间连续收治的 125 例确诊为 CDAD 的住院患者的回顾性数据。收集的数据包括患者基线时的特征、基础医学疾病、在诊断为 CDAD 之前的抗生素使用史、住院时间、CDAD 的严重程度、同时使用 PPIs、实验室参数、对 CDAD 治疗的反应以及成功治疗后 90 天内疾病的复发情况。比较了 CDAD 复发和未复发患者的各种临床和实验室参数。
结果
在 125 例发生 CDAD 的患者中（平均年龄 67.6 ± 13.9 岁），98 例（78.4%）未复发（非复发组），27 例（21.6%）复发（复发组）。在发生 CDAD 之前，125 例患者中有 96%接受了抗生素治疗，56 例（44.8%）患者同时使用了 PPIs。年龄大于 65 岁（P = 0.021）、经鼻胃管（NGT）喂养（P = 0.045）、血清白蛋白水平低（P = 0.025）和同时使用 PPIs（P = 0.014）是 CDAD 复发的单因素分析的危险因素。然而，性别、住院时间、抗生素使用时间和类型、疾病严重程度、白细胞计数和 C 反应蛋白（CRP）与 CDAD 复发的风险无关。多因素分析显示，年龄较大（>65 岁，调整后比值比：1.32，95%置信区间：1.12-3.87，P = 0.031）、血清白蛋白水平低（<2.5 g/dL，调整后比值比：1.85，95%置信区间：1.35-4.91，P = 0.028）和同时使用 PPIs（调整后比值比：3.48，95%置信区间：1.64-7.69，P = 0.016）是 CDAD 复发的重要危险因素。
结论
年龄较大、血清白蛋白水平<2.5 g/dL 和同时使用 PPIs 是 CDAD 复发的显著危险因素。
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