新生儿化脓性脑膜炎合并脑脓肿的临床特征和相关因素分析

Analysis of clinical characteristics and associated factors of neonatal purulent meningitis complicated with brain abscess

目的分析新生儿化脓性脑膜炎合并脑脓肿的临床特征和相关因素。方法回顾性选取2010年1月至2023年1月郑州大学附属儿童医院收治的化脓性脑膜炎合并脑脓肿的患儿,作为病例组;在未合并脑脓肿的新生儿化脓性脑膜炎患儿中,通过倾向性评分匹配中的1∶3最邻近匹配法选出对照组,匹配因素包括发病日龄≤7 d或>7 d、胎龄、出生体重、性别。收集患儿临床资料,分析两组患儿的病原菌分布、临床症状体征、辅助检查及转归的差异。采用多因素logistic回归模型分析新生儿化脓性脑膜炎合并脑脓肿的相关因素。结果病例组21例,男9例,女12例,年龄4.0~35.0(18.5±7.5)d;对照组63例,男26例,女37例,年龄5.0~41.0(19.4±9.4)d。病例组和对照组患儿血液和脑脊液病原体阳性率间的差异无统计学意义[61.9%(13/21)比47.6%(30/63),P=0.257]。病例组的治愈或好转的比例低于对照组[33.3%(7/21)比88.9%(56/63),P<0.001]。病例组的多重耐药细菌感染[47.6%(10/21)比12.7%(8/63),P<0.001]、惊厥[52.4%(11/21)比27.0%(17/63),P=0.033]、呼吸衰竭[57.1%(12/21)比14.3%(9/63),P<0.001]、感染性休克[52.4%(11/21)比3.2%(2/63),P<0.001]的发生率均高于对照组;病例组C反应蛋白(CRP)、脑脊液白细胞计数[M(Q_(1),Q_(3))]分别为[70.4(52.1,86.4)]mg/L、[1234(788,1606)]×10^(6)/L,均高于对照组的[45.0(25.7,57.8)]mg/L、[688(256,1089)]×10^(6)/L(均P<0.001)。多因素logistic回归模型分析发现,多重耐药细菌感染(OR=7.094,95%CI:1.335~37.705,P=0.022)、感染性休克(OR=30.102,95%CI:3.101~292.224,P=0.003)是新生儿化脓性脑膜炎合并脑脓肿的相关因素。结论新生儿化脓性脑膜炎合并脑脓肿患儿感染症状重,预后差,多重耐药细菌感染、合并感染性休克是新生儿化脓性脑膜炎合并脑脓肿的相关因素。

Objective To analyze the clinical characteristics and associated factors of neonatal purulent meningitis complicated with brain abscess.Methods Newborns with purulent meningitis complicated with brain abscess of Zhengzhou University Affiliated Children′s Hospital from January 2010 to January 2023 were retrospectively selected as the case group.Among neonatal meningitis patients without brain abscess,a control group was selected using the 1∶3 nearest neighbor matching method in propensity score matching,with matching factors including onset age≤7 days or>7 days,gestational age,birth weight,and gender.The clinical data of the patients were collected to analyze the differences in pathogen distribution,clinical symptoms and signs,auxiliary examinations,and outcomes between two groups.Multivariate logistic regression model was used to analyze the risk factors of neonatal purulent meningitis complicated with brain abscess.Results There were 21 cases in the case group,9 males and 12 females,aged 4.0-35.0(18.5±7.5)days;There were 63 cases in the control group,26 males and 37 females,aged 5.0-41.0(19.4±9.4)days.There was no statistically significant difference in the positive rates of blood and cerebrospinal fluid pathogens between the case group and the control group[61.9%(13/21)vs 47.6%(30/63),P=0.257].The proportion of cure or improvement in the case group is lower than that in the control group[33.3%(7/21)vs 88.9%(56/63),P<0.001].The incidence of multidrug-resistant bacterial infections[47.6%(10/21)vs 12.7%(8/63),P<0.001],convulsion[52.4%(11/21)vs 27.0%(17/63),P=0.033],respiratory failure[57.1%(12/21)vs 14.3%(9/63),P<0.001],and septic shock[52.4%(11/21)vs 3.2%(2/63),P<0.001]in the case group were all higher than those in the control group;C-reactive protein(CRP)and cerebrospinal fluid white blood cell count[M(Q_(1),Q_(3))]in case group were[70.4(52.1,86.4)]mg/L and[1234(788,1606)]×10^(6)/L,respectively,all higher than those in the control group[45.0(25.7,57.8)]mg/L,[688(256,1089)]×10^(6)/L(all P<0.001).Multivariate logistic regression model analysis revealed that multidrug-resistant bacterial infection(OR=7.094,95%CI:1.335-37.705,P=0.022)and septic shock(OR=30.102,95%CI:3.101-292.224,P=0.003)were associated factors for neonatal purulent meningitis complicated with brain abscess.Conclusions Children with neonatal purulent meningitis complicated with brain abscess have severe infection symptoms and poor prognosis.Multidrug-resistant bacterial infection and septic shock are the related factors of neonatal purulent meningitis complicated with brain abscess.