B族链球菌感染所致新生儿化脓性脑膜炎临床特点分析

Clinical analyses of 16 neonatal group B streptococcus meningitis cases

目的探讨B族链球菌(GBS)感染引起的新生儿化脓性脑膜炎临床特点及产前行GBS筛查的重要性。方法回顾性分析2010年3月至2015年2月我院新生儿科收治的新生儿化脓性脑膜炎病例资料,比较不同病原菌感染所致新生儿化脓性脑膜炎的临床特点,并对GBS感染病例的临床表现、治疗及转归进行分析。结果共纳入新生儿化脓性脑膜炎88例,GBS组16例(18.2%),非GBS组72例(81.8%)。GBS组和非GBS组脑脊液恢复正常的治疗时间分别为(23.6±10.1)、(8.6±4.0)天,住院时间分别为(40.3±17.6)、(27.4±6.7)天,神经系统并发症发生率分别为33.3%和8.3%,组间比较差异均有统计学意义(P<0.05)。GBS组早发型7例,晚发型9例;惊厥4例,头颅磁共振检查异常5例,死亡1例,重度智力发育落后和轻度运动发育落后各1例。88例患儿母亲均未行产前GBS筛查。结论新生儿GBS化脓性脑膜炎具有治疗难度大、住院时间长及神经系统并发症发生率高的特点,病程中出现惊厥可增加预后不良的风险。应重视孕期GBS筛查,早期防治。

Objective To study the clinical characteristics and outcomes of neonatal group B streptococcus（ GBS） meningitis,and to explore the major role of prenatal GBS screen. Methods A retrospective review was performed on neonates with purulent meningitis hospitalized in our Department from March 2010 to February 2015. The clinical characteristics of neonatal purulent meningitis caused by different pathogens were compared.The clinical features,treatments and clinical outcomes of neonatal GBS meningitis were analyzed. Results A total of88 cases of neonatal purulent meningitis in our Department. According to the etiologic agent,88 cases were assigned into GBS group [18. 2%（ 16 /88） ]and other pathogens group [81. 8%（ 72 /88） ]. The time for abnormal cerebral spinal fluid restored to normal and the days of hospitalization in GBS group were statistically longer than those in other pathogens group[（ 23. 6 ± 10. 1） d vs.（ 8. 6 ± 4. 0） d and（ 40. 3 ± 17. 6） d vs.（ 27. 4 ± 6. 7） d,P〈0. 05]. The incidence of neurological complications in GBS group was also statistically higher than that in other pathogens group（ 33. 3% vs. 8. 3%,P〈0. 05）. In GBS group,there were 7 early-onset cases and 9 late-onset cases. During hospitalization,4 patients presented seizure,5 patients were accompanied by abnormalities in cranial magnetic resonance imaging,and 1 patient died two days after admission. Follow up for a period of 6 months to 4 years in the remaining 15 cases,1 patient had severe mental retardation and another one had mild motor retardation. All the patient＇s mothers had no prenatal GBS screening.Conclusions Neonatal GBS meningitis is characterized by prolonged hospitalization and longer recovery time of abnormal cerebral spinal fluid results,higher incidence of neurological complications,as well as difficulty in treatment. Seizures may predict unfavorable prognosis. Prenatal prophylaxis,early diagnosis and therapy are vital for reducing the incidence of complications and mortality of neonatal GBS meningitis. It is necessary for the pregnant women to have routine screening for GBS infection.