早产儿微小脲原体脑膜炎1例报告并文献复习  

Ureaplasma parvum meningitis in a preterm infant:a case report and literature review

作　　者：谭琴 詹兴星 胡娅[1] 陈龙[1,2] Tan Qin;Zhan Xingxing;Hu Ya;Chen Long(Department of Neonatology,Children's Hospital of Chongqing Medical University(National Clinical Research Center for Child Health and Disorders,Ministry of Education Key Laboratory of Child Development and Disorders,Chongqing Key Laboratory of Pediatric Metabolism and Inflammatory Diseases),Chongqing 400014,China;Department of Neonatology,Women and Children's Hospital of Chongqing Medical University(Chongqing Health Center for Women and Children),Chongqing 400013,China)

机构地区：[1]重庆医科大学附属儿童医院新生儿科(国家儿童健康与疾病临床医学研究中心、儿童发育疾病研究教育部重点实验室、儿童代谢与炎症性疾病重庆市重点实验室),重庆400014 [2]重庆医科大学附属妇女儿童医院(重庆市妇幼保健院)新生儿科,重庆400013

出　　处：《中华围产医学杂志》2024年第8期680-687,共8页Chinese Journal of Perinatal Medicine

基　　金：重庆市教育委员会科学技术研究项目(KJQN202100419);国家儿童健康与疾病临床医学研究中心(重庆医科大学附属儿童医院)临床研究一般项目(NCRCCHD-2019-GP-13);重庆市妇幼疾病预防控制与公共卫生研究项目(CQFYJB01008)。

摘　　要：目的探讨新生儿脲原体脑膜炎的临床特点。方法回顾性分析2021年9月重庆医科大学附属儿童医院新生儿科收治的1例以脑脊液持续异常为主要表现的微小脲原体(ureaplasma parvum,UP)脑膜炎新生儿的临床表现、诊治及随访情况。以“新生儿”“脲原体”和“脑膜炎”为关键词,检索中国知网、万方医学数据库、中华医学期刊全文数据库、维普中文期刊数据库、中国生物医学文献服务系统和中国临床案例成果数据库;以“neonate”“ureaplasma”和“meningitis”为关键词,检索PubMed、Embase和Web of Science等数据库,检索时间为建库至2023年12月。结合本例,分析这些病例的临床特点。对数据资料采用描述性统计分析或χ^(2)检验(或Fisher精确概率法)。结果(1)病例资料:患儿女,1 h,出生胎龄30周+2,出生时有重度窒息,经外院机械通气、胸外按压等抢救后,转入本院新生儿重症监护病房。患儿7日龄出现惊厥,脑脊液检查示脑膜炎,血、脑脊液培养均阴性,经验性抗感染治疗1个月未见明显好转。39日龄脑脊液宏基因组二代测序(metagenomics next generation sequencing,mNGS)检查提示UP阳性,明确为UP脑膜炎。予以喹诺酮类抗生素抗感染10周。住院期间因脑积水行侧脑室腹腔分流术,病情好转后出院。随访至2岁1个月,有脑性瘫痪(偏瘫型),康复治疗中。(2)文献复习:检索到31篇文献,共46例患儿,加上本例患儿,共47例。47例患儿中,57%(27/47)为早产儿,54%(22/41)为低出生体重儿(部分文献未报告此项目,故分母小于47例,下同),76%(28/37)经阴道分娩出生。71%(24/34)在1周内起病,74%(26/35)母亲孕期合并脲原体感染或感染高危因素。主要表现包括发热[63%(20/32)]、惊厥发作或呼吸暂停/呼吸困难[各44%(14/32)],脑脊液检查主要表现为白细胞明显升高[287×106/L(69×106/L~1176×106/L)]、葡萄糖降低[0.79 mmol/L(0.10~1.17 mmol/L)]、蛋白升高[3.01 g/L(1ObjectiveTo explore the clinical characteristics of neonatal ureaplasma meningitis.MethodsA retrospective analysis was conducted on the clinical manifestations,diagnosis,treatment,and follow-up of a case of ureaplasma parvum(UP)meningitis in a neonate with persistent cerebrospinal fluid(CSF)abnormalities,admitted to the Neonatology Department of the Children's Hospital of Chongqing Medical University on September 2021.Literature was searched using the keywords"neonate","ureaplasma",and"meningitis"in databases including CNKI,Wanfang Medical Database,Yiigle,VIP Database,SinoMed,and Chinese Medical Care Repository,as well as PubMed,Embase,and Web of Science,from their inception to December 2023.The clinical characteristics of the cases obtained were analyzed in conjunction with the present case.Descriptive statistical analysis and Chi-square test(or Fisher's exact test)were used for data analysis.Results(1)Case report:The patient was a female neonate,born at 30+2 gestational weeks,who experienced severe asphyxia at birth and was transferred to the neonatal intensive care unit of our hospital after resuscitation involving mechanical ventilation and chest compressions at an external hospital.On the 7th day of birth,the patient developed seizures,and CSF examination indicated meningitis.Blood and CSF cultures were negative,and empirical anti-infective treatment for one month showed no significant improvement.On the 39th day of birth,metagenomics next generation sequencing(mNGS)of the CSF indicated UP positivity,confirming UP meningitis.The patient received ten weeks of quinolone antibiotics.During hospitalization,a ventriculoperitoneal shunt was performed due to hydrocephalus,and the patient was discharged after improvement.At 2 years and 1 month of follow-up,the patient had cerebral palsy(hemiplegic type)and was undergoing rehabilitation therapy.(2)Literature review:A total of 31 articles were retrieved,encompassing 46 cases,plus the present case,making a total of 47 cases.Among these,57%(27/47)were preterm infants,54

关 键 词：新生儿 化脓性脑膜炎 脲原体脑膜炎 宏基因组二代测序 

分 类 号：R722.6[医药卫生—儿科]