90例儿童化脓性脑膜炎病原学及临床表现和预后  

Etiological characteristics,clinical manifestations and prognosis of 90 children with purulent meningitis

作　　者：李承 孙丹[1] 王晶[1] 桑竹君 王海勤[1] LI Cheng;SUN Dan;WANG Jing;SANG Zhu-jun;WANG Hai-qin(Wuhan Children′s Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan,Hubei 430016,China)

机构地区：[1]华中科技大学同济医学院附属武汉儿童医院小儿神经内科,湖北武汉430016

出　　处：《中华医院感染学杂志》2022年第18期2856-2859,共4页Chinese Journal of Nosocomiology

基　　金：湖北省儿童神经发育障碍临床医学研究中心建设项目(HST2020-19-8)。

摘　　要：目的 探讨儿童化脓性脑膜炎病原学及临床表现和预后。方法 选择2017年01月-2021年10月华中科技大学同济医学院附属武汉儿童医院收治的90例PM患儿为研究对象,记录患儿发热、呕吐、头痛、腹痛、嗜睡和意识障碍等临床表现;检测脑脊液总蛋白、氯化物和葡萄糖水平;二分类Logistic回归分析PM患儿预后的影响因素。结果 PM患儿感染病原菌以金黄色葡萄球菌和大肠埃希菌为主;大肠埃希菌组PM患儿发热、呕吐和意识障碍发生率高于金黄色葡萄球菌组和其他病原菌组(P<0.05);与金黄色葡萄球菌组和其他病原菌组比较,大肠埃希菌组脑脊液(GSF)总蛋白、氯化物水平升高,葡萄糖水平降低(P<0.05);多因素Logistic回归分析结果显示,感染大肠埃希菌、GSF总蛋白水平≥3.95 g/L和GSF葡萄糖水平<0.93 g/L均为PM患儿不良预后的独立影响因素(P<0.05)。结论 PM患儿病原菌感染以金黄色葡萄球菌和大肠埃希菌为主,大肠埃希菌感染PM患儿CSF生化指标水平变化最为显著,感染大肠埃希菌、GSF总蛋白水平和GSF葡萄糖水平与PM患儿预后有关。OBJECTIVE To explore etiological characteristics,clinical manifestations and prognosis of children with purulent meningitis.METHODS A total of 90 children with PM who were treated in Wuhan Children′s Hospital,Tongji Medical College,Huazhong University of Science and Technology from Jan 2017 to Oct 2021 were recruited as the study subjects,the clinical manifestations including fever,vomiting,headache,abdominal pain,lethargy and disturbance of consciousness were recorded.The levels of total protein,chlorides and glucose in cerebrospinal fluid(CSF) were detected.Binary logistic regression analysis was performed for influencing factors for prognosis of the children with PM.RESULTS Staphylococcus aureus and Escherichia coli were dominant among the pathogens causing infections in the children with PM.The incidence rates of fever,vomiting and disturbance of consciousness were significantly higher in the E.coli group than in the S.aureus group and other pathogens groups(P<0.05).The levels of CSF total protein and chlorides of the E.coli group were significantly higher than those of the S.aureus group and other pathogens groups,while the glucose level of the E.coli group was significantly lower than that of the S.aureus group and other pathogens groups(P<0.05).The result of multivariate logistic regression analysis showed that E.coli infection,CSF total protein level no less than 3.95 g/L and GSF glucose level less than 0.93 g/L were the independent influencing factors for poor prognosis of the children with PM(P<0.05).CONCLUSION S.aureus and E.coli are the predominant species of pathogens causing infection in the children with PM.CSF biochemical indexes of the PM children with E.coli infection change most remarkably.E.coli infection,CSF total protein level and CSF glucose level are associated with the prognosis of the children with PM.

关 键 词：病原学 儿童 化脓性脑膜炎 临床表现 脑脊液生化指标 预后 金黄色葡萄球菌 大肠埃希菌 

分 类 号：R725.1[医药卫生—儿科]