儿童流行性脑脊髓膜炎16例临床特征和血清群分析  

Clinical characteristics and serogroup analysis of 16 pediatric cases of meningococcal meningitis

作　　者：姚婷新[1] 刘静[1] 刘芙蓉[1] 于四景[1] Yao Tingxin;Liu Jing;Liu Furong;Yu Sijing(Department of Infectious Diseases,Hunan Children′s Hospital,Changsha 410007,China)

机构地区：[1]湖南省儿童医院感染科,长沙410007

出　　处：《中华儿科杂志》2025年第3期293-297,共5页Chinese Journal of Pediatrics

摘　　要：目的探讨流行性脑脊髓膜炎(简称流脑)患儿的临床特征及血清群分布。方法病例系列研究,总结2014年4月至2024年3月湖南省儿童医院感染科收治的16例流脑患儿的人口学信息、实验室检查、疫苗接种史、诊断及治疗、预后等资料。根据患儿就诊年龄分为婴幼儿组(≤3岁)和学生组(6~15岁)。采用独立样本t检验和Mann-Whitney U检验进行组间比较。结果16例患儿中男、女各8例,就诊年龄4.25(0.33,12.30)岁。流脑呈散发状态,全年发病,11例来自农村。6例因年龄不足未接种疫苗。所有患儿均急性起病,从发病到出现神经系统症状时间为0.6(0.5,1.0)d,住院时间20(12,28)d。普通型10例,暴发型6例,热程≤7 d 7例,出现瘀点瘀斑8例,休克3例,呼吸衰竭3例,弥散性血管内凝血4例。婴幼儿组和学生组各8例,婴幼儿组抽搐5例,学生组头痛、恶心呕吐共6例,意识障碍4例。16例患儿C反应蛋白124.5(71.3,212.3)mg/L(正常值0~8.0 mg/L),降钙素原水平26.8(11.0,92.8)μg/L(正常值0~0.5μg/L)。婴幼儿组白细胞计数低于学生组[(7±4)×10^(9)比(17±10)×10^(9)/L,t=-2.36,P=0.034]。所有患儿病原学检测阳性,血清群鉴定结果显示C群、W135群、X群各1例,B群4例,Y群3例,未分群6例。共分离出脑膜炎奈瑟菌菌株10株,7株对磺胺类药物耐药,5株对青霉素耐药,3株对左氧氟沙星、环丙沙星耐药。9例患儿使用美罗培南,所有患儿均病情好转出院,无死亡患儿。出院时1例患儿出现极重度感音神经性耳聋,5例患儿因后遗症需康复治疗。结论儿童流脑主要发生在≤3岁和6~15岁,≤3岁患儿流脑的白细胞计数较低。脑膜炎奈瑟菌血清群多样性高,发现X和Y群流脑病例。分离出脑膜炎奈瑟菌对青霉素等抗生素耐药,在临床疗效不佳时需警惕耐药菌的存在。Objective To explore the clinical characteristics and serogroup distribution of meningococcal meningitis.Methods This study was a case series summary of the demographic data,laboratory results,vaccination history,clinical diagnoses,treatment and prognosis of 16 children with meningococcal meningitis who were hospitalized in Department of Infectious Diseases,Hunan Children′s Hospital from April 2014 to March 2024.According to ages,these patients were divided into infants and toddlers(≤3 years)and school-aged children(6-15 years)groups.Between-group comparison was performed using Independent samples t-test and Mann-Whitney U test.Results A total of 16 hospitalized patients were included,of whom 8 were male and 8 female.The age of these patients at visit was 4.25(0.33,12.30)years.The cases presented a sporadic distribution.There were 11 cases from rural regions,6 patients were unvaccinated due to age restriction.All patients presented with acute onset,with neurological symptoms manifesting within 0.6(0.5,1.0)days,and the duration of hospitalization was 20(12,28)days.There were 10 typical cases and 6 fulminant cases,with fever duration≤7 days in 7 cases.Clinical manifestations included petechiae and purpura in 8 cases,shock in 3 cases,respiratory failure in 3 cases,and disseminated intravascular coagulation in 4 cases.There were 8 cases in both the infant and toddlers group and the school-aged childrengroup,5 cases in the infant and toddler group manifested seizures.In contrast,in the school-aged children group,6 individuals exhibited headache,nausea,and vomiting,while 4 cases demonstrated signs of altered consciousness.The C-reactive protein level in the 16 patients was 124.5(71.3,212.3)mg/L,and the procalcitonin level was 26.8(11.0,92.8)μg/L,the normal values are 0-8.0 mg/L for C-reactive protein and 0-0.5μg/L for procalcitonin.Compared to the school-aged children group,the infants and toddlers group showed lower white blood cell counts((7±4)×10^(9)vs.(17±10)×10^(9)/L,t=-2.36,P=0.034).All patients teste

关 键 词：儿童 流行性脑脊髓膜炎 奈瑟球菌 脑膜炎 临床特征 血清群 

分 类 号：R725.1[医药卫生—儿科]