新生儿难治性化脓性脑膜炎临床及影像学特点分析  

Clinical and imaging characteristics in neonatal refractory purulent meningitis

作　　者：李淑涓 乔中伟[2] 蒋思远[1] 杨鸣姝[2] 程国强[1] 周琦[1] 曹云[1] 

机构地区：[1]复旦大学附属儿科医院新生儿科,上海201100 [2]复旦大学附属儿科医院放射科,上海201100

出　　处：《中华围产医学杂志》2016年第5期377-384,共8页Chinese Journal of Perinatal Medicine

基　　金：上海市科委自然科学基金（面上项目）（13ZR1404000）

摘　　要：目的：探讨新生儿难治性化脓性脑膜炎的临床及影像学特点。方法本研究为回顾性研究。收集2009年1月到2014年12月复旦大学附属儿科医院新生儿科收治的70例新生儿化脓性脑膜炎患儿的临床资料。根据所需抗感染治疗的疗程，分为难治组28例和普通组42例。分析新生儿难治性化脓性脑膜炎的临床和头颅MRI影像学特点。采用χ2检验、Fisher精确概率法、t检验或秩和检验进行统计学分析。将是否发生难治性化脓性脑膜炎作为因变量，结合新生儿的自身特点选取可能的影响因素进行分析。对单因素分析中有统计学意义的变量，采用Logistic回归分析进行变量筛选。结果70例患儿中，31例（44.3%）脑脊液和（或）血病原菌培养阳性。难治组病原菌以大肠埃希菌[8例（38.1%）]和B族链球菌[5例（23.8%）]为主，普通组病原菌以屎肠球菌为主（4例）。难治组与普通组比较，病程中惊厥发生率更高[53.6%（15/28）比7.1%（3/42），χ2=18.958，P＜0.01]，脑脊液白细胞数增多、蛋白含量增高、糖含量降低程度更显著[965.0（463.0~2200.0）×106/L 与116.5（61.0~327.5）×106/L，Z=－4.724；3221.1（2354.3~4633.5）与1487.6（988.2~1924.1）mg/L，Z=－4.669；0.2（0.1~0.8）与1.5（1.2~1.8）mmol/L，Z=－5.730；P值均＜0.01]，脑脊液/血病原学培养阳性率高[75%（21/28）比23.8%（10/42），χ2=17.843， P＜0.01]。Logistic回归分析表明，病程中出现惊厥、脑脊液糖含量降低、脑脊液或血液病原菌培养阳性提示易发展为新生儿难治性化脓性脑膜炎[OR值（95%CI）分别为9.6（1.2~76.0）、15.0（5.6~63.3）和7.3（1.5~36.0）]。与难治组头颅MRI异常发生率较普通组高[100.0%（28/28）与61.9%（26/42），χ2=13.827，P＜0.01]。难治组患儿头颅MRI更易出现脑外间隙异常[64.3%（18/28）与21.4%（9/42），χ2=13.023，P＜0.01]、脑室扩大[60.7%（17/28）与19.0%（8/42），χ2=Objective To identify the clinical and imaging characteristics in neonatal refractory purulent meningitis. Methods Clinical data of 70 cases of neonatal purulent meningitis admitted to the neonatal intensive care unit at Children＆#39;s Hospital of Fudan University from January, 2009 to December, 2014 were reviewed retrospectively. The patients were divided into refractory group （n=28） and non-refractory group （n=42） according to the course of antimicrobial therapy.The clinical and brain MRI characteristics of neonatal refractory purulent meningitis were analyzed. Parameters were compared between the two groups using Chi-square or Fisher＆#39;s exact tests, and Wilcoxon tests where appropriate. Risk factors of neonatal refractory purulent meningitis were investigated by univariate and multivariate Logistic regression analysis. Results Among the 70 cases, 31（44.3%） were positive for cerebrospinal fluid （CSF）/blood culture. The positive rate was higher in the refractory group than in the non-refractory group [75.0%（21/28） vs 23.8%（10/42）,χ2=17.843, P〈0.01]. The most common pathogenic bacteria isolated in the refractory group were Escherichia coli [8 cases （38.1%）] and group B streptococci [5 cases （23.8%）]. Compared to the non-refractory group, patients in the refractory group were more likely to have seizure, higher CSF white blood cell count, higher CSF protein concentration and lower CSF glucose concentration [53.6%（15/28） vs 7.1% （3/42）, 965.0 （463.0-2 200.0）×106/L vs 116.5 （61.0-327.5）×106/L, 3 221.1（2 354.3-4 633.5） mg/L vs 1 487.6（988.2-1 924.1） mg/L, and 0.2 （0.1-0.8） mmol/L vs 1.5 （1.2-1.8） mmol/L; all P〈0.01]. Multivariate Logistic regression analysis showed that seizure, low CSF glucose concentration on admission, and a positive CSF/blood culture result neonatal refractory purulent meningitis （OR=9.6, 95%CI： 1.2-76.0; OR=15.0, 95%CI： 5.6-63.3; and OR=7.3, 95%CI： 1.5-36.0, respectively）. Abnormal brain MRI findings, includi

关 键 词：脑膜炎 细菌性 磁共振成像 

分 类 号：R742.9[医药卫生—神经病学与精神病学]