新生儿中枢神经系统感染101例临床特征及病原学分析  

Clinical feature and etiological analysis of 101 neonates with central nervous system infection

作　　者：刘玉[1] 蒲伟丛 王乐[2] 郭映辉[3] 焦建成 夏耀方[1] 马莉[1] Liu Yu;Pu Weicong;Wang Le;Guo Yinghui;Jiao Jiancheng;Xia Yaofang;Ma Li(Department of Neonatology,Hebei Provincial Children′s Hospital Affiliated to Hebei Medical University,Shijiazhuang 050031,China;Pediatric Research Institute,Hebei Provincial Children′s Hospital Affiliated to Hebei Medical University,Shijiazhuang 050031,China;Department of Clinical Laboratory,Hebei Provincial Children′s Hospital Affiliated to Hebei Medical University,Shijiazhuang 050031,China)

机构地区：[1]河北医科大学附属河北省儿童医院新生儿科,石家庄050031 [2]河北医科大学附属河北省儿童医院儿科研究所,石家庄050031 [3]河北医科大学附属河北省儿童医院检验科,石家庄050031

出　　处：《中国小儿急救医学》2023年第8期578-583,共6页Chinese Pediatric Emergency Medicine

摘　　要：目的分析新生儿中枢神经系统感染的临床特征及病原学结果,为精准治疗、优化病原学检测策略提供依据。方法对2020年1月至2021年8月河北省儿童医院新生儿科收治的中枢神经系统感染患儿的临床资料进行数据收集,分析采用常规及分子生物学技术检出脑脊液病原学情况,比较不同种类病原体感染的实验室检查特点。结果共纳入101例患儿,中位出生胎龄为38.8(36.2,39.6)周,早产儿27例(26.7%),男婴68例(67.3%),中位发病日龄为9(2,14)d。血培养阳性19例(18.8%),其中17例细菌,2例真菌。自脑脊液直接检出病原体者33例(32.7%),其中细菌13例,病毒19例,真菌1例。无乳链球菌、大肠埃希菌是前2位细菌,检出最常见的病毒是肠道病毒。脑脊液病原体检出方式:细菌培养检出7例(7/101,6.9%)、脑脊液涂片检出2例(2/21,9.5%)、单病毒及多重聚合酶链反应方法共检出22例(22/45,48.9%)、宏基因组二代测序检出4例(4/7,57.1%)。自脑脊液检出细菌/真菌的患儿脑脊液白细胞计数、蛋白水平以及血C-反应蛋白均较检出病毒者高(P<0.05)。98例(97.0%)患儿临床好转或治愈后出院,2例放弃治疗,1例好转后转院。结论联合采用常规及分子生物学检测技术可显著提高新生儿中枢神经系统感染病原体检出率,病毒感染所致的新生儿中枢神经系统感染并不少见,本研究对优化新生儿中枢神经系统感染病原体的检测策略有指导意义。Objective To analyze the clinical features and etiological results of neonatal central nervous system(CNS)infection and provide basis for optimization of pathogen detection strategy for CNS infection.Methods We collected the clinical and laboratory data of hospitalized neonates with clinical diagnosis of CNS infection in the neonatal department at Hebei Provincial Children′s Hospital,from January 1,2020 to August 31,2021.The clinical manifestations of the enrolled neonates,as well as the cerebrospinal fluid(CSF)pathogens detected by conventional and molecular biological detection techniques were analyzed.Laboratory characteristics of different kinds of pathogen were compared.Results A total of 101 eligible neonates were enrolled.The median gestational age was 38.8(36.2,39.6)weeks,with a prematurity rate 26.7%.There were 68 boys.The median age of onset was 9(2,14)days.Blood culture was positive in 19(18.8%)cases,including 17 cases of bacteria and two cases of fungus.Positive findings were found in CSF specimens of 33(32.7%)cases by various methods including 13 bacteria,19 viruses and one fungi.Streptococcus group B and Escherichia coli were the first two bacteria in CSF.Enterovirus was the most common virus in CSF.In terms of detection methods of CSF pathogens,seven cases(7/101,6.9%)were detected by CSF culture,two cases(2/21,9.5%)by smear,22 cases(22/45,48.9%)by single-virus targeted/multiplex polymerase chain reaction and four cases(4/7,57.1%)by metagenomic next-generation sequencing.The CSF white blood cell counts,protein levels and blood C-reactive protein levels were higher in the cases with bacteria/fungi detection from CNS infection than in those with virus detection(P<0.05).Almost all neonates(98/101,97.0%)were clinically cured or significantly improved before discharge.Two neonates were discharged against medical advice and one neonate was transferred to the other hospital after clinical improvement.Conclusion Combined use of conventional and molecular biological detection techniques can significantly i

关 键 词：新生儿 中枢神经系统感染 聚合酶链反应 宏基因组二代测序 

分 类 号：R722.1[医药卫生—儿科] R742.9[医药卫生—临床医学]