Pseudomembranous Colitis: A Clinical Report from Southern Taiwan

偽膜性大腸炎：南台灣之臨床報告

郭仲謀(Chung-Mou Kuo) ； 胡琮輝(Tsung-Hui Hu) ； 郭仲煌(Chung-Huang Kuo) ； 羅元隆(Yuan-Lun Luo) ； 李禎祥(Chen-Hsiang Lee) ； 黃昭誠(Chao-Cheng Huang) ； 張簡吉幸(Chi-Sin Changchien) ； 蔡成枝(Seng-Kee Chuah)

《內科學誌》 19卷3期 (2008/06) Pp. 253-259

https://doi.org/10.6314/JIMT.2008.19(3).09

摘要

偽膜性大腸炎是一種常與住院相關的疾病。本篇回顧性研究是南台灣治療偽膜性大腸炎的臨床經驗。從1996年l月至2005年12月共收集59位偽膜性大腸炎病人（33男性，26女性；平均年齡60.9±5.4歲，年齡分佈26-84歲）。雖然本院無法檢測cytotoxin，主要診斷依據是乙狀結腸鏡或大腸鏡發現配合糞便培養陽性。病患分成三群：A群8位具有輕度症狀，B群41位具有中度症狀，C群10位具有嚴重症狀。35位病患先前有使用抗生素治療，其中14位使用cephalosporin。重要的影響因素包括年齡大於65歲，血性腹瀉，發燒，白血球增加與低白蛋白血症。24位接受口服vancomycin治療，76%有反應，6位無反應，包括2位復發，4位病患屬於C群。26位接受metronidazole治療，88.5%有反應，3位無反應，包括l位復發。所有無反應者除2位癌症病患死於復發，其餘皆靠改變治療抗生素治癒。全部死亡率爲3.4%。我們建議metronidazole應作爲治療偽膜性大腸炎的首選藥物，因其較符合治療經濟效益。年齡大與較差健康狀況者較易從中度症狀進展至嚴重症狀。

並列摘要

Pseudomembranous colitis is a disease commonly associated with hospitalization. This retrospective study shares the experience of treating pseudomembranous colitis in a Taiwanese hospital. From January 1996 to December 2005, fifty-nine patients, 33 males and 26 females with mean age of 60.9 ± 5.4 years (ranging from 26-84 years-old) were included into this retrospective study. The diagnosis was based on either by sigmoidoscopy or colonoscopy and confirmed by a pathologist and/or by a positive stool culture study. Patients were divided in to 3 groups: group A with mild symptoms and diarrhea 3-5 times per day (n=8); group B having moderate symptoms with diarrhea more than 6 times per day, and stable vital signs but without massive or bloody diarrhea (n=41); group C having severe symptoms and signs of massive, watery or bloody diarrhea, and signs of toxic megacolon, and unstable vital signs implying hypovolemic shock (n=10). Several clinical variables and treatment outcomes were compared. Thirty-five of the patients had prior antibiotics exposure with cephalosporin most commonly associated (n=14). Significant variables were, age ＞65 year-old, bloody diarrhea, fever, leukocytosis, and hypoalbuminemia. Twenty-five patients received oral vancomycin treatment, 76% were responders, and 6 were non-responders which included 2 recurrences. Four patients belonged to group C. Twenty-six patients received metronidazole treatment and 88.5% were cured. Three patients were treatment failures (one recurred) and all were cured by shifting to the alternate regimen, but 2 cancer patients with relapses died. The overall mortality rate was 3.4%. We conclude that metronidazole is generally recommended as a first drug of choice in treating pseudomembranous colitis, which also has a cost-benefit. Age ＞65 year-old and poor general health statuses are the relevant risk factors for developing into moderate to severe PMC. High suspicion is important in patients with gastrointestinal symptoms especially those with prior exposure to antibiotics or high-risks patients with long-term hospitalization.

並列關鍵字

Pseudomembranous colitis ； Clostridium difficile ； Vancomycin ； Metronidazole