儿童细菌性脑膜炎病原菌及炎症指标与预后相关分析  

The correlation analysis of pathogen,inflammation index and prognosis of bacterial meningitis in children

作　　者：李阳 王育民 图雅 LI Yang;WANG Yumin;TU Ya(Department of Pediatric Internal Medicine,Inner Mongolia Maternal and Child Health Hospital,Hohhot,Inner Mongolia,010010,China)

机构地区：[1]内蒙古自治区妇幼保健院儿内科,内蒙古呼和浩特010010

出　　处：《当代医学》2024年第2期29-33,共5页Contemporary Medicine

摘　　要：目的了解内蒙古中西部地区儿童细菌性脑膜炎(BM)的临床特点和病原菌分布情况,探究影响BM不良预后的危险因素。方法回顾性分析2014年1月至2020年6月于内蒙古自治区妇幼保健院新生儿科和儿内科住院且主要诊断为BM的47例患儿的临床资料,包括一般情况、临床表现、头颅影像学、发病72 h内血白细胞计数(WBC)、中性粒细胞比例、血清C-反应蛋白(CRP)、降钙素原(PCT)、入院后第一次脑脊液(CSF)检查等。根据随访情况,将患儿分为预后不良组(n=32)与预后良好组(n=15)。比较两组实验室指标、病原菌分布情况,并采用多因素Logistic回归分析患儿预后不良的独立危险因素。结果47例患儿中,男女比例为1.61∶1;新生儿(≤28 d)20例,婴儿15例,1~3岁幼儿7例,≥3岁儿童5例;来自城市31例,来自农村16例。47例患儿病原菌均为阳性,其中肺炎链球14例,大肠埃希菌12例,屎肠球菌7例,肺炎克雷伯杆菌5例,余病原菌9例;47例患儿中发热42例,意识障碍25例,惊厥发作23例,精神反应差16例,呕吐12例。预后良好组与预后不良组年龄、性别、民族、地区、临床表现(发热、精神反应差、呕吐)、病原菌分布情况、血WBC、中性粒细胞比例及CSF-WBC、CSF-IgG、CSF-乳酸脱氢酶(LDH)、CSF-氯化物水平比较差异无统计学意义;预后不良组惊厥发作、意识障碍发生率,头颅影像学检查异常占比,血CRP、PCT及CSF-蛋白定量水平均高于预后良好组,CSF-糖水平低于预后良好组,差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,有意识障碍、PCT水平升高、CSF-糖水平低为患儿预后不良的独立危险因素(P<0.05)。结论内蒙古中西部地区儿童BM高发年龄为<1岁,男性为主,城市高于农村,主要病原菌为肺炎链球菌、大肠埃希菌和屎肠球菌,临床表现以发热、意识障碍、惊厥发作为主,意识障碍、发病72 h内PCT水平升高、入院后CSF-糖水平降�Objective To investigate the clinical features and distribution of pathogenic bacteria in children with bacterial meningitis(BM)in central and western Inner Mongolia,and to explore the risk factors affecting the poor prognosis of BM.Methods The clinical data of 47 pediatric patients admitted to the Neonatology and Pediatric departments of Inner Mongolia Maternal and Child Health Hospital from January 2014 to June 2020 with a primary diagnosis of bacterial meningitis were retrospectively analyzed,including general conditions,clinical manifestations,head imaging,blood white blood cell count(WBC)within 72 h of onset,neutrophil ratio,serum C-reactive protein(CRP),procalcitonin(PCT),and the first examination of cerebrospinal fluid(CSF)after admission.According to the follow-up,the children were divided into the poor prognosis group(n=32)and the good prognosis group(n=15),the laboratory indexes and the distribution of pathogenic bacteria were compared between the two groups,and the independent risk factors of poor prognosis were analyzed by multivariate Logistic regression.Results Among the 47 cases,the male to female ratio was 1.61∶1;there were 20 cases of newborns(≤28 d),15 cases of infants,7 cases of infants aged 1 to 3 years,and 5 cases of children aged≥3 years;there were 31 cases from urban areas and 16 cases from rural areas.Pathogenic bacteria were positive in all 47 cases,including streptococcus pneumoniae in 14 cases,Escherichia coli in 12 cases,Enterococcus faecium in 7 cases,Klebsiella pneumoniae in 5 cases,and residual pathogenic bacteria in 9 cases.Among the 47 cases,42 had fever,25 cases had disturbance of consciousness,23 cases had convulsion,16 cases had poor mental response,and 12 cases had vomiting.There was no significant difference in age,gender,nationality,region,clinical manifestations(fever,poor mental response,vomiting),pathogen distribution,WBC,neutrophil ratio and CSF-WBC,CSF-IgG,CSF-LDH,CSF-chloride levels between the good prognosis group and the poor prognosis group,the incidence of co

关 键 词：儿童 细菌性脑膜炎 病原菌 炎症指标 预后 

分 类 号：R512.3[医药卫生—内科学]