不同年龄组儿童艰难梭菌感染临床特点及预后影响因素

Clinical characteristics and prognosis influencing factors of Clostridium difficile infection in children of different age groups

摘要

目的 分析不同年龄儿童艰难梭菌感染(Clostridium difficile infection, CDI)的临床特征及预后，探讨疾病复发的危险因素。方法 回顾性分析山东大学附属儿童医院 2019 年 1 月-2024 年 12 月收治的 63 例初发 CDI 患儿的临床资料，按年龄分为婴幼儿组(n=29,<3 岁)和儿童组(n=34,3~12 岁);根据治疗后是否复发分为复发组(n=11)和未复发组(n=52)。应用 Mann-Whitney U 检验及 χ² 检验比较两组临床数据资料，总结临床及内镜特征，并通过二元 logistic 回归分析 CDI 复发的危险因素，以受试者工作特征(receiver operating characteristic, ROC)曲线分析影响因素对复发的预测价值。结果 婴幼儿组以腹泻、便血最常见，儿童组以腹泻、腹痛、便血最常见。儿童组腹痛发生率(73.52% vs. 34.48%)和血沉水平[7.00(3.75,10.25)mm/h vs. 3.00(2.00,5.00)mm/h]高于婴幼儿组，差异有统计学意义(P<0.05)。所有患儿均进行了结肠镜检查，婴幼儿组结肠镜检查阳性率为 62.06%，结肠镜分度以轻度为主;儿童组结肠镜检查阳性率为 64.70%，结肠镜分度以中度为主;婴幼儿组肠镜分度低于儿童组，差异有统计学意义(P<0.05)。根据患儿病情选择单一或联合药物抗感染治疗，出院 2 个月随访显示，两组患儿复发率(17.24%vs 17.65%)差异无统计学意义(P>0.05)。对复发组和未复发组进一步分析显示，复发组合并炎症性肠病率(36.36%vs.1.92%)、血白细胞计数[(12.72±2.44) ×10⁹/L vs.(8.89±3.15) ×10⁹/L]、C 反应蛋白[11.49(7.31,13.67)mg/L vs.3.20(1.56,3.65) mg/L]、粪便钙卫蛋白[341.90(226. 80,431. 00)/μg/g vs. 89. 30(29.03,183.28)/μg/g]水平高于未复发组，复发组血清前白蛋白[(139.00±26.87)mg/L vs. (170.70±46.27)mg/L]水平低于未复发组，差异有统计学意义(P<0.05)。二元 logistic 回归分析结果显示，高粪便钙卫蛋白(OR =1.009,95%CI:1.001~1.017)是 CDI 患儿复发的独立危险因素，ROC 曲线显示粪便钙卫蛋白预测复发的曲线下面积为 0.886，灵敏度为0.727，特异度为0.942，最佳截断值为 300.30μg/g。结论 不同年龄儿童 CDI 临床症状及炎症标志物差异不大，结肠镜分度具有一定差异，高粪便钙卫蛋白可能是 CDI 患儿复发的独立危险因素，需引起临床医师的重视。

Abstract

Objective To analyze the clinical characteristics and prognosis of Clostridium difficile infection (CDI) in children of different age groups and to explore risk factors for disease recurrence. Methods Clinical data from 63 children with initial CDI admitted to Children's Hospital of Shandong University from January 2019 to December 2024 were retrospectively analyzed. Patients were divided into infant group (n=29,<3 years) and child group (n=34,3~12 years). Based on post-treatment recurrence, they were further categorized into recurrence group (n=11) and non-recurrence group (n=52). Employing statistical methods such as the Mann-Whitney U test and χ² test, this study compared clinical data between two groups, summarized clinical and endoscopic characteristics, and identified risk factors for CDI recurrence through binary logistic regression analysis, with the predictive value of these factors for recurrence evaluated using receiver operating characteristic (ROC) curve analysis. Results Diarrhea and hematochezia were most common in infant group, while diarrhea, abdominal pain, and hematochezia predominated in child group. The incidence of abdominal pain (73.52 % vs. 34.48%) and erythrocyte sedimentation level [7.00(3.75,10.25) mm/h vs. 3.00(2.00,5.00)mm/h] were significantly higher in child group than in infant group (P<0.05). All patients underwent colonoscopy. The colonoscopy positivity rate was 62.06% in infant group (predominantly mild), and 64.70% in child group (predominantly moderate). The infant group exhibited a lower degree of endoscopic severity compared to the child group (P<0.05). Patients received single or combined anti-CDI therapy. At 2-month follow-up, there was no significant difference in recurrence rates (17.24% vs. 17.65%) between two groups (P>0.05). Further analysis of recurrence (11 cases) and non-recurrence (52 cases) groups showed higher rate of inflammatory bowel disease (36.36% vs. 1.92%), higher white blood cell count [(12.72±2.44)×10⁹/L vs. (8.89±3.15)×10⁹/L], higher C-reactive protein [11.49(7.31,13.67)mg/L vs. 3.20(1.56,3.65)mg/L], higher fecal calprotectin [341.90(226.80,431.00)μg/g vs. 89.30(29.03,183.28)μg/g] levels in recurrence group (P<0.05) and lower serum prealbumin [(139.00±26.87)mg/L vs. (170.70±46.27)mg/L] in recurrence group (P<0.05). Binary logistic regression identified high fecal calprotectin (OR=1.009,95%CI:1.001~1.017) was an independent risk factor for recurrence in children with CDI. ROC curve analysis demonstrated that fecal calprotectin predicted recurrence with an area under the curve of 0.886, a sensitivity of 0.727, a specificity of 0.942, and an optimal cut-off value of 300.30μg/g. Conclusion Clinical symptoms and inflammatory markers of CDI vary minimally between age groups, but colonoscopy severity differs. High fecal calprotectin may be an independent risk factor for recurrence, warranting clinical attention.

关键词

儿童 / 艰难梭菌感染 / 临床表现 / 结肠镜特征 / 危险因素

Key words

Children / Clostridium difficile infection / Clinical manifestations / Colonoscopic features / Risk factors

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基金资助

山东省自然科学基金面上项目(ZR2022MH132)