儿童结核性脑膜炎营养因素与临床结局的关系分析  

Relationship between nutritional factors and clinical outcome in children with tuberculous meningitis

作　　者：任敏 陈理雪 舒敏[1] 李雪 李银月 钟小玲 朱渝[1] 郭琴[1] 廖琼[1] 温杨[1] 罗双红[1] 万朝敏[1] Ren Min;Chen Lixue;Shu Min;Li Xue;Li Yinyue;Zhong Xiaoling;Zhu Yu;Guo Qin;Liao Qiong;Wen Yang;Luo Shuanghong;Wan Chaomin(Department of Pediatric Infectious Diseases,West China Second Hospital,Sichuan University,Key Laboratory of Obstetric&Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education,Chengdu 610041,China)

机构地区：[1]四川大学华西第二医院感染儿科出生缺陷与相关妇儿疾病教育部重点实验室,成都610041

出　　处：《中华儿科杂志》2022年第3期221-226,共6页Chinese Journal of Pediatrics

基　　金：“十三五”国家科技重大专项(2018ZX10103001);中国健康促进基金会重症结核性脑膜炎患儿临床营养支持临床研究(16H0954);成都市科学局儿童发热的流行病学研究(2015-HM01-00419-SF)。

摘　　要：目的明确结核性脑膜炎(TBM)患儿营养风险状况与临床结局的关系。方法回顾性分析2013年1月至2020年12月在四川大学华西第二医院儿科住院的112例TBM患儿临床症状和实验室检查结果等资料,应用营养风险筛查评估量表进行营养风险筛查和评估,根据评分将患儿分为营养风险组和非营养风险组,采用t检验、秩和检验或χ^(2)检验分析两组间临床症状、实验室指标等临床资料差别,应用多因素Logistic回归方程,对营养风险影响因素进行分析。结果112例TBM患儿中男55例、女57例。营养风险组62例,非营养风险组50例,营养风险发生率为55.4%(62/112)。营养风险组居住农村的患儿、出现脑神经受损、抽搐、消瘦、纳差的症状、确诊时间≥21 d的患儿、脑脊液蛋白量均高于非营养风险组[50例(80.6%)比32例(64.0%)、20例(32.3%)比8例(16.0%)、33例(53.2%)比15例(30.0%)、30例(48.4%)比2例(4.0%)、59例(95.2%)比1例(2.0%),41例(66.1%)比18例(36.0%)、1406(1079,2068)比929(683,1208)mg/L,χ^(2)=3.91、3.90、6.10、26.72、98.58、10.08,Z=4.35,均P<0.05],营养风险组的血清白蛋白浓度、血红蛋白浓度、淋巴细胞计数、白细胞计数和脑脊液糖含量均低于非营养风险组[(36±5)比(41±4)g/L、(110±17)比(122±14)g/L、1.4(1.0,2.0)×10^(9)比2.3(1.6,3.8)×10^(9)/L、7.8(6.3.10.0)×10^(9)比10.0(8.3,12.8)×10^(9)/L、1.0(0.8,1.6)比2.1(1.3,2.5)mmol/L,t=-6.15、-4.22,Z=-4.86、-3.92、-4.16,均P<0.05]。血清白蛋白浓度增高(OR=0.812,95%CI:0.705~0.935,P=0.004)和淋巴细胞计数增加(OR=0.609,95%CI:0.383~0.970,P=0.037)可能降低TBM患儿营养风险;抽搐症状(OR=3.853,95%CI:1.116~13.308,P=0.033)、脑脊液蛋白量增加(OR=1.001,95%CI:1.000~1.002,P=0.015)可能增加TBM患儿营养风险。营养风险组较非营养风险组的并发症、药物性肝损伤发生的患儿均更多[47例(75.8%)比15例(30.0%)、31例(50.0%)比8例(16.0%),χ^(2)=23.50、14.10,均P<0.05],住院时间更长[(27±1Objective To investigate the relationship between nutritional risk status and clinical outcome in children with tuberculous meningitis(TBM).Methods The clinical data(basic information,clinical symptoms and laboratory test results)of 112 patients with TBM,who were admitted to Department of Pediatric Infectious Diseases of West China Second Hospital of Sichuan University,from January 2013 to December 2020 were retrospectively analyzed.The patients were divided into the nutritional risk group and the non-nutritional risk group according to the assessment of the nutritional risk by the STRONGkids Scale.The variables of basic information,clinical symptoms and laboratory test measurements etc.were compared between the two groups by using Student t test,Rank sum test or Chi-square test.Multivariate Logistic regression analysis were used to analyze nutritional risk factors.Results Among 112 patient with TBM,55 were males and 57 females.There were 62 cases in the nutritional risk group and 50 cases in the non-nutritional risk group.The proportion of cases with nutritional risk was 55.4%(62/112).Patients in the nutritional risk who lived in rural areas,had symptoms of brain nerve damage,convulsions,emaciation and anorexia,with a diagnosis time of≥21 days,and the level of cerebrospinal fluid(CSF)protein were all higher than those in the non-nutritional risk group 50 cases(80.6%)vs.32 cases(64.0%),20 cases(32.3%)vs.8 cases(16.0%),33 cases(53.2%)vs.15 cases(30.0%),30 cases(48.4%)vs.2 cases(4.0%),59 cases(95.2%)vs.1 case(2.0%),41 cases(66.1%)vs.18 cases(36.0%),1406(1079,2068)vs.929(683,1208)mg/L,χ^(2)=3.91,3.90,6.10,26.72,98.58,10.08,Z=4.35,all P<0.05.The levels of serum albumin,hemoglobin,lymphocyte count,white blood cell count,and CSF glucose were significantly lower in patients with nutritional risk(36±5)vs.(41±4)g/L,(110±17)vs.(122±14)g/L,1.4(1.0,2.0)vs.2.3(1.6,3.8)×10^(9)/L,7.8(6.3,10.0)×10^(9)vs.10.0(8.3,12.8)×10^(9)/L,1.0(0.8,1.6)vs.2.1(1.3,2.5)mmol/L,t=-6.15,-4.22,Z=-4.86,-3.92,-4.16,all P<0.05.Increased leve

关 键 词：结核 脑膜 儿童 营养状况 

分 类 号：R529.3[医药卫生—内科学]