2023 年第 3 期 第 18 卷

化脓性脑膜炎婴儿不同病原菌感染临床特征及近期预后不良的危险因素分析

Analysis on clinical characteristics and risk factors of poor short-term prognosis in purulent meningitis infants with different pathogenic infection

作者：王思璇郭凌云胡冰陈天明冯文雅刘琳琳窦珍珍刘钢

英文作者：Wang Sixuan Guo Lingyun Hu Bing Chen Tianming Feng Wenya Liu Linlin Dou Zhenzhen Liu Gang

单位：国家儿童医学中心儿科重大疾病研究教育部重点实验室首都医科大学附属北京儿童医院感染内科，北京100045

英文单位：Department of Infection Beijing Children′s Hospital Capital Medical University National Center for Children′s Health Key Laboratory of Major Diseases in Children Ministry of Education Beijing 100045 China

关键词：化脓性脑膜炎；预后；危险因素

英文关键词：Purulentmeningitis;Prognosis;Riskfactors

• 摘要：

• 目的 分析化脓性脑膜炎婴儿不同病原菌感染的临床特点及近期预后不良的危险因素。方法 回顾性收集首都医科大学附属北京儿童医院感染内科2018年10月1日至2020年12月1日收治的99例化脓性脑膜炎婴儿的病历资料。根据脑脊液或血培养结果，将婴儿分为肺炎链球菌组（A组，14例）、大肠埃希菌组（B组，13例）、其他病原菌组（C组，15例）及培养阴性组（D组，57例）。记录婴儿的临床特征、败血症发生情况、实验室检查指标、头颅磁共振成像及近期预后。结果 99例婴儿以发热［68例（68.7%）］、精神反应弱［54例（54.5%）］为主要临床表现。4组婴儿发病年龄、发病年龄30~90 d比例、入院体质量、住院时间≥21 d比例、胎膜早破比例、抽搐比例及颈强直比例比较，差异均有统计学意义（均P＜0.05）。共33例（33.3%）婴儿合并败血症，4组败血症发生率比较差异有统计学意义（P＜0.05）。4组外周血白细胞计数（WBC）、降钙素原水平和脑脊液WBC、乳酸水平、葡萄糖＜2.22 mmol/L比例、蛋白>1.5 g/L比例、葡萄糖/血糖比值、硬膜下积液比例比较，差异均有统计学意义（均P<0.05）。多因素Logistic回归分析结果显示，发病年龄30~90 d（比值比=0.560,95%置信区间：0.005~0.612）、脑脊液蛋白＞1.5 g/L（比值比=30.329,95%置信区间：2.262~406.681）、脑脊液葡萄糖<2.22 mmol/L（比值比=4.035,95%置信区间：1.051~15.495）为化脓性脑膜炎婴儿近期预后不良的独立危险因素（均P<0.05）。结论 婴儿化脓性脑膜炎以发热及精神反应弱为主；血液和脑脊液培养阳性率高，肺炎链球菌、大肠埃希菌是其主要病原菌。发病年龄30~90 d、脑脊液蛋白>1.5 g/L、脑脊液葡萄糖<2.22 mmol/L是近期预后不良的独立危险因素。

• Objective  To analyze the clinical characteristics and risk factors for poor short-term prognosis in purulent meningitis infants with different pathogenic infection. Methods  From October 1, 2018 to December 1, 2020, clinical information of 99 infants with purulent meningitis admitted to Department of Infection, Beijing Children′s Hospital, Capital Medical University were retrospectively analyzed. According to the result of cerebrospinal fluid or blood culture, infants were divided into Streptococcus pneumoniae group (group A, 14 cases), Escherichia coli group (group B, 13 cases), other pathogen group (group C, 15 cases) and negative culture group (group D, 57 cases). The clinical characteristics, occurrence of septicemia, laboratory indexes, cranial magnetic resonance imaging and short-term prognosis of infants were recorded. Results  Fever ［68 cases (68.7%)］ and weak mental response ［54 cases (54.5%)］ were the main clinical symptoms in 99 infants. There were significant differences in onset age, the rate of onset age at 30-90 d, admission body mass, rates of length of stay ≥21 d, premature rupture of membranes, convulsions, and cervical ankylosis among the four groups (all P<0.05). Septicemia was developed in 33 cases (33.3%), and the incidence of septicemia was significantly different among the four groups (P<0.05). There were significantly differences in peripheral white blood cell count (WBC) and procalcitonin, cerebrospinal fluid WBC, lactic acid levels, the rate of glucose <2.22 mmol/L, the rate of protein > 1.5 g/L, cerebrospinal fluid glucose/blood glucose ratio and the rate of subdural effusion among the four groups (all P<0.05). Multivariate Logistic regression analysis showed that onset age at 30-90 d (odds ratio=0.560, 95% confidence interval: 0.005-0.612), cerebrospinal fluid protein >1.5 g/L (odds ratio=30.329, 95% confidence interval: 2.262-406.681) and cerebrospinal fluid glucose <2.22 mmol/L (odds ratio=4.035, 95% confidence interval: 1.051-15.495) were independent risk factors for poor short-term prognosis in infants with purulent meningitis (all P<0.05). Conclusions  Fever and weak mental response are the main clinical symptoms in infants with purulent meningitis; blood and cerebrospinal fluid cultures are highly positive, and Streptococcus pneumoniae and Escherichia coli are the main pathogens. The risk factors of poor short-term prognosis in the infants include onset age at 30-90 d, cerebrospinal fluid protein >1.5 g/L and cerebrospinal fluid glucose <2.22 mmol/L.