为监测儿童腹泻中艰难梭菌相关性腹泻（Clostridium difficile-associated diarrhea, CDAD）的发病情况，并对其进行回顾性临床分析，我们对上海市儿科医院2007年2月到2007年9月的腹泻儿童粪便标本共111名病例，进行了艰难梭菌毒素A检测及粪便厌氧菌培养，并对所有入组儿童进行回顾性的病史采集及分析。以及对粪便培养所得的4株艰难梭菌菌株用多位点重复片段分析法（Multi-Locus VNTR Assay, MLVA）进行同源性分析。在这些病例中未发现CD毒素A检测及培养均为阳性的患者，而毒素A阳性、CD培养（-）者16例；毒素A阴性、CD培养阳性者4例；CD毒素A阴性、培养阴性者共91例。分别比较院内院外二组3种不同病程腹泻中CDAD的发生率，均无显著差别（P>0.05）。所有入选病人的粪便标本培养阳性者共4株，经MLVA法分析发现有部分同源性。因此，我们认为，上海地区儿童艰难梭菌相关性腹泻目前为散发病例，但彼此之间有部分同源性。院内获得性和院外获得性腹泻在CDAD发病率上未发现差异。CD毒素A阳性或者培养阳性的病例在临床表现上与CD毒素A阴性以及培养阴性的腹泻类型未发现显著的差异。

In order to explore the incidence of Clostridium difficile-associated diarrhea(CDAD)  among children of diarrhea and to give a retrospective clinical analysis of this kind of diarrhea, we employed an ELISA-based assay of Clostridium difficile toxin A to the stool samples of children with diarrhea from February 2007 to September 2007 in Children’s Hospital of Fudan University. Anaerobic bacteria culture was also performed for each recruited sample. Four cultured Clostridium difficile strains were isolated and subjected to a Multi-Locus VNTR Assay(MLVA) to investigate the epidemiological information. 111 cases were recruited, among which none cases were positive for both toxin A investigation and anaerobic bacteria culturing, 16 cases were toxin A positive while culture negative, 4 cases were toxin A negative while culture positive, and 91 cases were either toxin A positive nor culture positive. The comparison of the incidence of CDAD of different courses between hospital-acquired and community-acquired infection has shown no statistically significant differences(P>0.05). The four cultured Clostridium difficile isolates were found to related to each other to some extent in the phylogenetic tree. In conclusion, the Clostridium difficile infection in Shanghai is sporadic, but may related phylogeneticly to some extent. The clinical manifestation of CDAD is of no specialty than those without evidence of CD infections.