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。     

抗生素在体内外对厌氧菌和艰难梭菌细胞毒素生成的作用

氯林霉素、灭滴灵和甲砜霉素对大多数肠道厌氧菌的生长具抑制作用。氯林霉素还会破坏肠道菌群平衡,使原来受抑制的艰难梭菌得以定植,并在艰难梭菌浓度达10~8/g盲肠内含物时,检测到艰难梭菌细胞毒素。培养基中亚抑菌浓度的氯林霉素和灭滴灵会推迟艰难梭菌细胞霉素的生成。灭滴灵还可保护无菌小鼠及受氯林霉素处理的悉生小鼠免遭艰难梭菌细胞毒素的致死作用,从而证实了灭滴灵在伪膜性结肠炎临床治疗中的可用性。     

艰难梭菌A毒素的细胞致死活性研究

本文报道艰难梭菌Ａ毒素对４种培养细胞的细胞致死活性的探讨。４种培养细胞为Ｖｅｒｏ（非洲绿猴肾细胞）细胞、ＴＰＣ─１（人甲状腺肿瘤细胞）细胞、ＮＩＨ３Ｔ３细胞（小鼠成纤维细胞）及将ｒａｓ癌基因转基因于ＮＩＨ３Ｔ３细胞的ＮＩＨ３Ｔ３ｒａｓ细胞。应用台酚蓝排除能试验、噻唑蓝（ＭＴＳ）比色、细胞膜损害测定试验、荧光显微术观察细胞核的形态变化等测定Ａ毒素细胞致死活性。实验表明：４种培养细胞系对Ａ毒素细胞圆缩化作用的敏感性依次为ＮＩＨ３Ｔ３ｒａｓ,ＴＰＣ─１,Ｖｅｒｏ,ＮＩＨ３Ｔ３细胞。而对Ａ毒素细胞致死活性的敏感性依次为ＴＰＣ─１,ＮＩＨ３Ｔ３,Ｖｅｒｏ,ＮＩＨ３Ｔ３ｒａｓ细胞。从而得知Ａ毒素的细胞致死活性不但依细胞种类不同而不同,而且也不一定与Ａ毒素的细胞圆缩化作用有关。肿瘤细胞ＴＰＣ─１细胞对Ａ毒素致死活性有特殊敏感性。以上结果对探索抗癌新药的研制具有重要意义。     

婴幼儿艰难梭菌的无症状定植与防治措施研究进展

艰难梭菌是一种肠道条件致病菌,能形成芽胞有效抵抗抗生素的杀灭.由于临床上抗生素的不规范使用,导致人体肠道有益菌被杀死.艰难梭菌因抵抗力强而大量繁殖,破坏人体肠道菌群平衡,引起抗生素相关性腹泻.艰难梭菌同时也是院内感染的主要病原菌.艰难梭菌可在人体肠道无症状定植,不同年龄阶段艰难梭菌定植率有较大差异,相比于成人,婴幼儿时...     

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.     

艰难梭菌的检验

本文简要述及艰难梭菌毒素A和毒素B检验中的一些问题,着重于A^-B^ 分离菌株的检验,包括细菌培养、毒素的组织培养检定、毒素和共同抗原的酶联免疫吸附试验等,并对检验结果的临床意义进行了分析和讨论。     

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。     

艰难拟梭菌毒素致病机制及毒素基因调控的研究进展

艰难拟梭菌(Clostridioides difficile)是一种产芽孢的革兰氏阳性专性厌氧杆菌,是引起抗生素相关性腹泻的主要致病菌。艰难拟梭菌产生的毒素A和毒素B在其致病过程中发挥关键作用。毒素发挥毒性作用依赖其4个功能结构域:葡萄糖基转移酶结合域、半胱氨酸蛋白酶结合域、易位域和受体结合域。毒素的受体结合域识别并结合细胞表面受体,介导毒素内吞并形成内体。经过自体催化切割,毒素将真正的毒性片段——葡萄糖基转移酶结合域释放到胞浆中,葡萄糖基转移酶能够失活宿主肠上皮细胞内的GTP酶导致细胞骨架解聚和坏死,进而引起腹泻和伪膜性结肠炎等临床症状。艰难拟梭菌毒素产生受致病基因座内及基因座外许多调控因子的调节。tcdR和tcdC基因位于致病基因座内,对毒素基因的表达分别起促进和抑制作用,而基因座外如spo0A、codY等基因则通过抑制tcdR的表达从而间接影响毒素蛋白产生。本文将重点介绍艰难拟梭菌毒素的致病过程和影响毒素基因表达的分子调控机制,以期为开发针对毒素的治疗手段提供新思路。     

Toxins A and B of Clostridium difficile

Abstract: The toxins produced by Clostridium difficile share several functional properties with other bacterial toxins, like the heat-labile enterotoxin of Escherichia coli and cholera toxin. However, functional and structural differences also exist. Like cholera toxin, their main target is the disruption of the microfilaments in the cell. However, since these effects are not reversible, as found with cholera toxin, additional mechanisms add to the cytotoxic potential of these toxins. Unlike most bacterial toxins, which are built from two structurally and functionally different small polypeptide chains, the functional and binding properties of the toxins of C. difficile are confined within one large polypeptide chain, making them the largest bacterial toxins known so far.     

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...     

1993年美国疫苗可防性疾病情况及儿童免疫计划

１９９３年美国疫苗可防性疾病情况及儿童免疫计划美国儿童常规接种白喉、ｂ型流感杆菌（Ｈｉｂ）、乙型肝炎、麻疹、腮腺炎、百日咳、脊髓灰质炎、风疹相破伤风这９种疫苗。公共卫生监督和流行病学评估表明儿童接种疫苗对发病率有实质性的影响。１９９３年１２月美国未发...     

兰州市婴幼儿艰难梭菌带菌状况

在兰州市随机采集的２１６名健康婴幼儿粪标本经分离并对其培养特性、菌落菌体形态特征、生化反应特性以及毒素原性等进行一系列检查,检出了３７人的粪便含有艰难梭菌（１０４─１０８／ｇ）,检出总阳性率为１７．１％,新生儿、婴儿及幼儿各年龄组的检出阳性率分别为１３．５％（１９／４１）、３３．３％（１３／３９）、１３．９％（５／３６）。３７株分离菌中毒素原性阳性者仅有８株（２１．６％）,均分布于婴儿与幼儿两组。新生儿１４１人中２７人的粪标本为胎粪,只有１人（３．７％）含艰难梭菌（２×１０６／ｇ）,但不产毒素。所有婴幼儿中有２２人因各种原因曾用过抗菌药物,但仅有２人的粪便含艰难梭菌,而且均为非产毒株,表明艰难梭菌检出率与药物服用之间似无显著的相关性。     

酶联免疫吸附试验检测艰难梭菌A毒素

实验用兔单特异抗艰难梭菌Ａ毒素ＩｇＧ包被酶标板,以羊抗艰难梭菌Ａ毒素ＩｇＧ标记辣根过氧化物酶作为第二抗体,采用双抗体夹心ＥＬＩＳＡ法检测艰难梭菌Ａ毒素,可检测出０．９４ｎｇ的精制Ａ毒素,对６１株菌的培养液及６５份健康人粪便标本检测发现此法具有较高的特异性。用平行线定量法对几份典型产毒培养物进行了定量测定,结果表明,在一定剂量范围内线性及平行性好,结果准确、可靠。可用于临床粪便标本中艰难梭菌Ａ毒素的筛查及定量检测。     

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.     

Nucleotide sequence of Clostridium difficile toxin A gene fragment and detection of toxigenic strains by polymerase chain reaction

A 1947 base pair (bp) fragment of the toxin A gene of Clostridium difficile was sequenced. A continuous open reading frame was found, which contained 4 distinct groups of repeat nucleotide sequence with 88 to 100% identity within each group. The arrangement of the groups (A, 81 bp, B, C and D, 63 bp) was ABCCCDABCDDABCCCDABCCDABCDABC. Based on nucleotide sequence data from the C repeat group, a pair of oligonucleotide primers were synthesised and used in the polymerase chain reaction (PCR) to amplify fragments from the toxin A gene. Several products of multiples of 63 bp length were amplified for all 33 toxigenic C. difficile strains tested in contrast to the 12 non-toxigenic strains tested which failed to amplify any product. This rapid technique is of potential use in the specific identification of toxigenic C. difficile strains in mixed culture and from clinical specimens.     

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.     

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.