回顾性分析成人化脓性脑膜炎细菌构成及其脑脊液分布特点

A retrospective analysis of the bacterial records of cerebrospinal fluid and characteristics of purulent meningitis in adults

目的回顾性分析宁夏地区成人化脓性脑膜炎(purulent meningitis in adult,APM)患者脑脊液(cerebrospinal Fluid,CSF)细菌构成及特点。方法收集宁夏医科大学总医院2002年01月至2014年07月诊治并行细菌培养的144例化脓性脑膜炎患者临床资料,分析比较致病菌检出阳性与阴性的实验室检查特点,以及不同致病菌(革兰阳性球菌、革兰阴性杆菌及革兰阳性杆菌)患者之间实验室检查特点。结果 144例化脓性脑膜炎的细菌检出阳性率为36.8%(53例),致病细菌以革兰阳性球菌常见[64.15%(34例)],其中以葡萄球菌属为主;细菌检出阳性组患者的血中性粒细胞比例、脑脊液白细胞计数及脑脊液蛋白含量均高于阴性组(分别(82.52±9.43)%,(78.13±13.25)%,P=0.022;(4078.13±5739.24)×10~6/L,(2181.61±4440.87)×10~6/L,P=0.010;(2.99±2.67)g/L,(2.18±2.01)g/L,P=0.041)。发病10d内就诊的101例患者,细菌检出阳性组脑脊液压力、脑脊液白细胞计数、脑脊液中性粒细胞比例亦均高于阴性组((263.82±55.05)mmH_2O,(236.03±66.26)mmH_2O,P=0.032;(4660.45±5756.37)×10~6/L,(2745.97±5193.33)×106/L,P=0.008;(70.21±30.51)%,(56.79±35.54)%,P=0.048),脑脊液淋巴细胞比例较阴性组低((18.92±24.10)%,(32.02±32.10)%,P=0.023)。结论成人化脓性脑膜炎的致病菌以革兰阳性球菌多见,其细菌培养阳性患者的脑脊液与培养阴性者具有一定差异,可能会为临床诊疗提供参考价值。

Objective To retrospective1 y analyze the bacterial records of cerebrospinal fluid（CSF）of purulent meningitis in adult（APM）in Ningxia,and explore its CSF characteristics.Methods In total,144 patients of definite APM admitted to the General Hospital of Ningxia Medical Universitybetween January 2002 and July 2014 were studied.The pathogenic bacterial constitution and drug sensitivity tests were analyzed.The CSF features were compared between CSF culture negative and positive groups and among gram-positive bacillus,gram-negative bacillus,and gram-positive coccus.Results The positive bacterial detection rate was 36.8%（53）.The main causative bacteria were gram-positiv ecocci（64.15%,34）,of which the main pathogenic bacteria were staphylococcocci.The blood neutrophils ratio,CSF WBC counts and CSF protein level in the CSF culture positive group were higher than the culture negative group [（82.52±9.43）%,（78.13±13.25）%,P=0.022;（4078.13±5739.24）×10~6/L,（2181.61±4440.87）×10~6/L,P=0.010;（2.99±2.67）g/L,（2.18±2.01）g/L,P=0.041].In the patients arriving at hospital within ten days,the CSF pressure,CSF WBC counts,CSF neutrophils ratio in the CSF culture positive group were higher than the culture negative group[（263.82±55.05）mmH2O,（236.03±66.26）mmH2O,P=0.032;（4660.45±5756.37） ×106/L,（2745.97±5193.33）×10~6/L,P=0.008;（70.21±30.51）%,（56.79±35.54）%,P=0.048],and the CSF lymphocyte ratio was lower in the culture positive group than the culture negative group [（18.92±24.10）%,（32.02±32.10）%,P=0.023].Conclusions The main causative bacteria in APM aregram-positive cocci.There are significant differences between the CSF culture positive group and the culture negative group,which may be useful to guide the clinical practice.