艰难梭菌研究现状

艰难梭菌(Clostridium difficile,CD)是产芽胞革兰阳性厌氧菌,产毒素艰难梭菌可导致艰难梭菌感染(Clostridium difficile infection,CDI)。产毒素艰难梭菌已被公认是抗菌药物相关性腹泻最常见的病原体,也是发达国家最常见的导致住院患者腹泻感染的原因之一。高毒力菌株导致全世界范围内CDI的发病率和死亡率增加。如何快速而准确地检测CD一直是备受关注的问题,国内外多推荐两步法和三步法进行检测。艰难梭菌治疗的一线用药是甲硝唑、万古霉素以及非达霉素,应用粪便微生物移植(faecal microbiota transplantation,FMT)也可作为治疗轻度或严重复发CDI(recurrence Clostridium difficile infection,rCDI)的可选方法。艰难梭菌的芽胞能抵抗不良环境,但抗菌药物的使用,医院环境的复杂性和医务工作者的手等因素会导致艰难梭菌易于传播,因此医疗机构应加强艰难梭菌的预防。本文主要对艰难梭菌的流行病学、致病机制、检测及治疗进行综述。     

艰难梭菌实验室快速鉴定方法检验效能的比较

目的评价3种艰难梭菌实验室鉴定方法的快速性及准确性。方法 2013年6月至2013年11月,收集136名ICU患者共248份标本进行24 h、48 h厌氧培养,并进行鉴定,同时对大便标本提取DNA进行tcd B毒素基因检测。以48 h培养结果为参考标准,评价24小时培养法和PCR扩增tcd B基因法鉴定艰难梭菌的灵敏度、特异度、阳性预测值和阴性预测值。结果 136名ICU发生腹泻的患者中,11名患者共有12份标本48 h培养为艰难梭菌阳性,艰难梭菌感染率为8.09%(11/136),标本阳性率为4.84%(12/248)。24小时培养法及PCR扩增tcd B基因法的灵敏度、特异度、阳性预测值、阴性预测值分别为75.00%、100%、100%、98.74%和83.33%、99.15%、83.33%、99.15%。结论提取大便DNA tcd B毒素基因是最快速、灵敏度和特异度均较高的方法;48小时培养法时间相对较长,但稳定可靠,并可以保留菌株进行后续试验;24小时培养法,时间短、简便但会漏诊某些阳性病例。     

3种检测艰难梭菌方法的临床应用评估

本研究旨在对3种检测粪便样本中艰难梭菌的方法进行临床应用评估,为艰难梭菌的实验室检测提供参考。采用艰难梭菌毒素A/B(Clostridium difficile toxins A and B,CDAB)酶联免疫荧光检测法、环丝氨酸-头孢西丁-果糖琼脂(cycloserin-cefoxitin-fructose agar,CCFA)常规培养法和显色培养法(chromID~(TM))同步检测粪便样本中的艰难梭菌,并对培养所得菌株进行tcdB基因扩增以验证其产毒性。以艰难梭菌培养联合tcdB基因扩增为参考方法,分别计算上述3种方法的灵敏度、特异度、阳性预测值和阴性预测值等参数,分析其与参考方法的一致性。研究共收集临床粪便样本164份,参考方法检测结果为58份阳性,106份阴性。经统计分析,艰难梭菌毒素A/B法的灵敏度、特异度、阳性预测值和阴性预测值分别为51.7%、95.3%、85.7%和78.3%,CCFA常规培养法分别为72.4%、98.1%、95.5%和86.7%,而艰难梭菌显色培养法分别为94.8%、92.5%、87.3%和97.0%。3种方法中,艰难梭菌显色培养法与参考方法的一致性最高(Kappa=0.856)。采用该方法检测粪便样本中的艰难梭菌操作简便,成本经济,结果判断直观、准确,具有较好的临床应用价值。     

一种测定艰难梭菌荚膜多糖分子量的简便方法

本文采用两种规格的Ｓｅｐｈａｒｏｓｅ４Ｂ凝胶层析柱,测定了艰难梭菌荚膜多糖的分子量,并建立了一种较为简便、敏感的测定方法,对进一步研究英膜多糖的生物学特性提供了有利条件。     

艰难梭菌粘附的研究进展

艰难梭菌粘附的研究进展厦门大学生物系厦门３６１００５王隽,苏文金“艰难梭菌（Ｃｌｏｓｔｒｉｄｉｕｍｄｉｆｆｉｃｉｌｅ）是重要的肠道致病厌氧菌。它是抗生素疗法所引起的伪膜性结肠炎的致病菌,并且是引起抗生素相关的腹泻的最主要病原菌之一,同时还与一些非抗生...     

艰难梭菌的研究进展

艰难梭菌为革兰阳性厌氧芽胞杆菌,可引起艰难梭菌相关性腹泻,导致一系列肠道感染症状和相关临床表现。近年来由于高致病株的出现、菌株耐药性的增加,艰难梭菌感染在全球呈蔓延趋势。本文就艰难梭菌的耐药机制、检测技术、防治及国内感染现状等作一简要综述。     

艰难梭菌相关性腹泻的治疗进展及对我国的启示

艰难梭菌相关性腹泻（Clostridium difficile associated diarrhea,CDAD）是艰难梭菌感染（Clostridium difficile Infection,CDI）引起的一种机体严重疾病。随着艰难梭菌感染率的增加及高毒力株027／NAP1／BI的出现,导致该病在全球特别是北美、及欧洲等地区爆发性流行,对于该病的控制引起全球研究者的高度重视。本文就其治疗进展进行综述,并结合我国实际分析该病防治中存在的问题并提出建议。     

艰难梭菌的超微结构观察

本文用扫描、负染、超薄切片等电镜技术对三株国外引进的艰难梭菌参考菌株作了超微结构的观察。在电镜下，艰难梭菌表现为长短不．的粗大杆菌，表面平整，未见鞭毛和菌毛。菌细胞壁两侧平行，有两个电子致密层和中间透明区结构，与细胞膜之间呈典型的双层单位膜。胞质中充满核糖体和散在的核区，并可见到与细胞膜相连的侧中膜小体。此外还观察到典型的芽胞以及存在于细胞壁外的荚膜结构。本实险结果为深入研究艰难梭菌的结构和功能提供了参考资料。     

酪酸梭菌对艰难梭菌感染的防治研究

目的:观察酪酸梭菌对艰难梭菌感染的防治效果.方法:用艰难梭菌产毒株人工感染BALB/C小鼠,感染前后分别用酪酸梭菌进行预防与治疗,并检测盲肠内容物细胞毒性和进行肠黏膜病理观察.结果:酪酸梭菌不能预防艰难梭菌的感染,但在艰难梭菌感染后则能明显降低艰难梭菌的产毒力和盲肠黏膜的病理损伤.结论:酪酸梭菌对小鼠艰难梭菌感染有明显的治疗作用.     

艰难梭菌的快速鉴定试验

<正>现已充分证明,假膜性结肠炎几乎都是由艰难梭菌引起的,而且,抗生素相关性腹泻(约占25％)也与之有关。其实验诊断主要是取病人的粪便分离培养艰难梭菌,然后再行鉴定。然而现行的鉴定方法不是费时、需要贵重的仪器设备,就是重复性差或需要作补充鉴定试验。本文报道的是一种快速(30分钟内)、准确、重复性良好的确证方法。     

Comparison of methods for the production and purification of toxin A from Clostridium difficile

Abstract The production and purification of toxin A from Clostridium difficile were studied. When the toxin was produced in dialysis culture it preicipitated quantitatively at pH 5.5 and after purification it appeard homogeneous in polyacrylamide gel electrophoresis (PAGE). The toxin probably consists of two noncovalently bound peptides, each with a molecular mass of about 250 dDa. It is resistant to trypsin but sensitive to papain and chymotrypsin. In contrast, toxin A produced in anaerbic chamber culture precipitated poorly at pH 5.5 (yield 14%) and easily formed aggregates as observed in gel filtration and PAGE Accordingly, dialysis culture seems to be a better method for producing and purifying toxin A.     

Production of an enterotoxin different from toxin A by Clostridium difficile

Abstract Clostridium difficile has been demonstrated to produce at least two toxins: an enterotoxin (toxin A) which elicits haemorrhagoc fluid accumulation in the rabbit ileal loop (RIL) test and a potent cytotoxin (toxin B). We report the isolation of an enterotoxic factor inducing a positive response in the RIL test without haemorrhage. This factor was separated by ion-exchange chromatography and its molecular weight, as estimated by SDS-polyacrylamide gel electrophoresis, was about 45 000.     

Characterization of immunogenic p230 as the toxin A of Clostridium difficile

Abstract For the identification of toxin A of Clostridium difficile , a 2-dimensional gel system was used. In its first dimension, samples were separated in the absence of reducing and dissociating agents, conditions which maintained the activity of the enterotoxin. This was followed by reduction and dissociation in the second dimension where a 230 kDa polypeptide was electroeluted. Rabbits were immunized with polyacrylamide gel slices containing entrapped native toxin A and the denatured 230 kDa protein. As revealed by immunoblotting, neutralizing antisera derived from native protein samples recognized the native toxin, the denatured 230 kDa protein and another polypeptide of about M _r 35 000. Using both types of antisera as probes the pI of the enterotoxin was about 5.9. Preliminary evidence suggests that the enterotoxin is a multimeric protein of 230 kDa and 35 kDa subunits.     

Clostridium difficile lacks detectable superantigen activity

Clostridium difficile colitis causes striking leukocytosis. We examined the possibility that toxins A or B, or other nontoxin products of C. difficile, act as superantigens, thereby stimulating leukocytosis. Our results failed to show major histocompatibility complex class II-dependent T lymphocyte proliferation, the hallmark of superantigen activity. Elevated white blood cell counts in C. difficile colitis are probably due to increased generation of cytokines such as interleukin-6 (IL-6) or IL-8.     

The cell wall proteins of Clostridium difficile

Abstract The proteins which can be released by 6 M urea treatment from the cell walls of Clostridium difficile represent the major cell surface proteins. In the 5 strains examined there are one to three of these major proteins. They appear to be strain-specific antigens being detected in immunoblots only with homologous antiserum. A common cell-surface protein of M _r 73 kDa has been identified as a minor component of the urea extract.     

Detection of fimbriae amongst strains of Clostridium difficile

Abstract Five of 15 strains of Clostridium difficile possessed multiple polar fimbriae which were 4–9 nm in diameter and up to 6 μm long. There was no direct correlation between the presence or absence of fimbriae and the toxigenic status of the organism.     

Clostridium difficile electrophoretic typing

Abstract Two typing schemes for Clostridium difficile based on slide agglutinations and polyacrylamide gel electrophoresis (PAGE) have been described. We compared the reference strains of each typing system with a simplified PAGE method using whole cells and Coomassie blue staining. The method was also applied to clinical isolates and immunoblots were performed with a monospecific serum directed against a major band of low molecular weight. The results indicated the great heterogeneity of Clostridium difficile strains complicated by antigenic subdivision for strains belonging to the same electrophoretic type.     

载体的自动和被动免疫在婴儿对Hib结合菌苗应答中的相反作用

载体的自动和被动免疫在婴儿对Ｈｉｂ结合菌苗应答中的相反作用为了探索预先用载体蛋白破伤风类毒素（ＴＴ）或同时用ＴＴ免疫婴儿获得的对ＴＴ的主动免疫及从母体获得的被动免疫同ｂ型流感嗜血杆菌荚膜多糖－破伤风类毒素结合菌苗（ＨｉｂＣＰ－ＴＴ）免疫应答之间的关系...