标题：新生儿化脓性脑膜炎不同细菌感染的临床特点及近期预后不良危险因素分析

      作者：李承燕，黄炳龙，王优    广东医科大学附属医院儿科，广东 湛江 524001

      卷次： 2021年32卷6期

      【摘要】 目的 探讨新生儿化脓性脑膜炎不同细菌感染的临床特点及近期预后不良危险因素。方法 回顾性分析2014年1月至2019年12月广东医科大学附属医院新生儿科收治的95例化脓性脑膜炎患儿的临床资料。按不同病原菌感染分为大肠埃希菌组20例、其他菌种组15例及培养阴性组60例，比较各组患儿的临床特点及实验室检查结果等指标，并通过多因素逐步回归分析近期预后不良危险因素。结果 大肠埃希菌组及其他菌种组患儿的前囟膨隆发生率分别为35.00%、40.00%，明显高于培养阴性组的13.33%，差异均有统计学意义(P<0.05)，而三组患儿的产式、胎膜早破、发热、反应低下、肌张力增高、意识障碍等发生率比较差异均无统计学意义(P>0.05)；大肠埃希菌组患儿的脑脊液白细胞总数、总蛋白含量、腺苷脱氨酶(ADA)值明显高于其他两组，而糖浓度明显低于其他两组，差异均有统计学意义(P<0.05)，而其他菌种组患儿的脑脊液总蛋白含量、白细胞总数明显高于培养阴性组，差异均有统计学意义(P<0.05)；三组患儿的外周白细胞计数(WBC)、降钙素原(PCT)、C反应蛋白(CRP)、乳酸脱氢酶(LDH)值、血钙及血钠等指标比较差异均无统计学意义(P>0.05)；多因素Logistic回归分析结果显示，治疗时间长(>21 d)、脑脊液糖<1.5 mmol/L及脑脊液总蛋白>1 500 mg/L为影响新生儿化脓性脑膜炎近期预后不良的独立危险因素(P<0.05)。结论 大肠埃希菌感染的新生儿化脓性脑膜炎前囟膨隆发生率高，大肠埃希菌感染的脑脊液呈现脓性改变；影响新生儿化脓性脑膜近期预后不良独立危险因素有治疗时间长、低脑脊液糖浓度及高脑脊液总蛋白。
      【关键词】 化脓性脑膜炎；病原菌；临床特点；预后；危险因素
      【中图分类号】 R722.1 【文献标识码】 A 【文章编号】 1003—6350（2021）06—0723—04

Clinical characteristics and risk factors of adverse prognosis of neonatal purulent meningitis caused by differentpathogens.
LI Cheng-yan, HUANG Bing-long, WANG You. Department of Pediatrics, Affiliated Hospital of GuangdongMedical University, Zhanjiang 524001, Guangdong, CHINA
【Abstract】 Objective To identify the clinical characteristics of different bacterial infections and the risk fac-tors of short-term poor prognosis in neonatal purulent meningitis. Methods The clinical data of 95 children of neonatalpurulent meningitis, admitted to the Affiliated Hospital of Guangdong Medical University from January 2014 to Decem-ber 2019, were reviewed retrospectively. According to the infection of different pathogens, the children were divided intoEscherichia coli group (20 cases), other strains group (15 cases), and culture-negative group (60 cases). The clinical char-acteristics and laboratory results were compared between each group, and the risk factors of recent poor prognosis wereanalyzed by multivariate stepwise regression analysis. Results The incidence of anterior fontanelle swelling in Esche-richia coli group and other strains group were 35.00% and 40.00%, retrospectively, which were significantly higher than13.33% in culture-negative group. There was no significant difference in delivery patterns, premature rupture of mem-branes, fever, low response, hypermyotonia, and disturbance of consciousness. The cerebrospinal fluid (CSF) whiteblood cell count, CSF total protein, and adenosine deaminase (ADA) value in Escherichia coli group were significantlyhigher than those in other strains group and culture-negative group, while CSF glucose concentration were significantlylower. CSF total protein content and white blood cell count in other strains group were significantly higher than those inculture-negative group (P<0.05). The white blood cell count of peripheral blood (WBC), procalcitontin (PCT), C-reac-tive protein (CRP), lactate dehydrogenase (LDH) value, sodium and calcium value were not statistically differentamong the three groups. Multivariate logistic regression analysis showed that longer treatment time (>21 days), CSFglucose<1.5 mmol/L, and CSF total protein>1 500 mg/L were the independent risk factors of the short-term prognosisof neonatal purulent meningitis. Conclusion The incidence rate of anterior fontanelle swelling in children of neonatalpurulent meningitis caused by Escherichia coli was significantly higher. Escherichia coli infection can cause purulent CSF.Longer treatment time, low CSF glucose, and high total CSF protein were the independent risk factors for short-termpoor prognosis of neonatal purulent meninges.
      【Key words】 Purulent meningitis; Pathogenic bacteria; Clinical characteristics; Prognosis; Risk factors