新生儿B族溶血链球菌感染早发型与晚发型的临床研究

The clinical study on the early onset and late onset B group hemolytic streptococcus infection in neonates

目的 探讨新生儿B族溶血链球菌（group B streptococcus,GBS）感染早发型和晚发型的临床表现及早发型GBS感染的危险因素.方法 收集2010年1月至2016年6月深圳市新生儿GBS感染研究协作组各单位收治的GBS感染新生儿临床资料,出生7d内发病者为早发型,出生7d后发病者为晚发型.采用1∶1配对原则选取同期胎龄相同、体重相近的非GBS感染患儿为早发型对照组.对早发型和晚发型患儿的临床表现进行病例对照研究,分析GBS的耐药性及早发型的危险因素.结果 共收集110例GBS感染病例,其中早发型73例,晚发型37例;对照组73例.早发型GBS感染68.5％合并肺炎、69.9％合并败血症、21.9％合并脑膜炎;晚发型GBS感染97.3％合并败血症、45.9％合并脑膜炎、40.5％合并肺炎,早发型和晚发型临床表现差异有统计学意义（P =0.002）.GBS对青霉素的敏感率为100％,万古霉素敏感率为99.0％,红霉素耐药率为82.5％,克林霉素耐药率为84.5％.Logistic回归分析显示,经阴道分娩是早发型GBS感染的独立危险因素（OR=2.776,95％ CI1.377～5.624,P=0.005）.结论 新生儿GBS感染早发型以肺炎和败血症为主要表现,晚发型以败血症和脑膜炎为主要表现,均首选青霉素治疗.经阴道分娩是新生儿早发型GBS感染的独立危险因素.

Objective To study the clinical manifestations of the early onset and late onset neonatal Group B streptococcus （GBS） infection,and then to study the risk factors of early onset GBS infection.Method Neonates with GBS infection from January 2010 to June 2016 were collected by Neonatal GBS Infection Research Cooperative Group in Shenzhen.Neonates had the disease within 7 days after birth were in the early onset group.Neonates had the disease beyond 7 days after birth were in the late onset group.Neonates with similar gestational age and weight were chosen as control group for early onset group by 1 ∶ 1 in Shenzhen people’s hospital.Clinical manifestations of early onset group and late onset group were analyzed by case control study,and risk factors of early onset group were analyzed by logistics regression analysis.Drugs sensitivity of GBS were also analyzed.Result A total of 110 neonates with GBS infection wereincluded in our study,73 in the early onset group and 37 in the late onset group.And the control group has 73 cases.In the early onset group,68.5% had pneumonia,69.9% had sepsis,and 21.9% had meningitis,however,in the late onset group,97.3% had sepsis,45.9% had meningitis,and 40.5% had pneumonia.The difference between the two groups had statistical significance （P =0.002）.The susceptibility rate of GBS against penicillin and Vancomycin was 100% and 99.0%,respectively.82.5% of GBS were resistant to Erythromycin,and 84.5% were resistant to Clindamycin.The independent risk factor of early onset GBS infection was vaginal delivery （OR =2.776,95% CI 1.377 ～ 5.624,P =0.005）.Conclusion The early onset type of neonatal GBS infection mainly manifested as pneumonia and sepsis while the late onset type mainly manifested as sepsis and meningitis.The penicillin was recommended in the neonatal GBS infection.The independent risk factor of early onset neonatal GBS infection was the vaginal delivery.