新生儿B族链球菌败血症临床特征及危险因素分析

Clinical features of neonatal group B Streptococcus for septicemia and its risk factors analysis

目的探讨新生儿B族链球菌(group B Streptococcu,GBS)所致败血症的临床特征及易感因素。方法收集2014年6月1日-2017年6月31日在温州市人民医院阴道分娩并患有败血症的新生儿91例为研究对象,取血培养标本91例。根据血培养结果分为GBS阳性组与非GBS组,对2组新生儿发病情况进行分析。结果 91例败血症新生儿GBS血培养阳性患者为25例,阴性66例。GBS阳性组新生儿惊厥、神经系统并发症、并发脑膜炎等临床表现方面发生率显著高于非GBS组;GBS阳性组新生儿外周血CRP>100 mg/L、白细胞计数<5×10~9/L、脑脊液白细胞>100×10~6/L高于非GBS组;GBS阳性组孕妇胎膜早破、孕期GBS感染的发生率高于非GBS组,差异均有统计学意义(P<0.05)。Logistic回归分析提示,孕妇生殖道GBS定植是新生儿GBS感染的独立危险因素(OR=34.21,95%CI:3.17~368.4,P<0.01)。结论新生儿GBS败血症并发症多,病情更加凶险,应对孕妇进行常规筛查并治疗,对孕妇有产科高危因素的新生儿应加强监测。

Objective To study the clinical features of neonatal group B Streptococcus（ GBS） for septicemia and its risk factors.Methods A retrospective cohort study of 91 newborns with GBS septicemia who were delivered in the People＇ s Hospital of Wenzhou from June 2014 to June 2017,91 blood samples were tested by standard bacterial culture,which were divided into two groups（ GBS positive group and the non-GBS group） according to the outcome of the GBS test. The clinical date of the two groups was compared. Results In the 91 cases,25 cases were found GBS positive,66 cases were negative. The incidence rates of neonatal seizures,neurological complications,meningitis and other clinical manifestations in GBS positive neonates were significantly higher than non-GBS group; CRP〉 100 mg/L,white blood cell count〈 5 × 10~9/L,and the ratio of cerebrospinal fluid leukocytes 〉100 × 10~6/L were higher than that of non-GBS group. The incidence rates of premature rupture of membranes and GBS infection during pregnancy in GBS positive group were significantly higher than that in non-GBS group,with the differences above all statistically significant（ P〈 0. 05）. Logistic analysis found that the diffection of GBS in late pregnancies was an independent risk factor of GBS septicemia on neonatus（ OR = 34. 21,95% CI： 3. 17-368. 4,P〈 0. 01）. Conclusion GBS sepsis with multiple complications had high death rate,routine maternal tests of GBS in late pregnant women may be necessary and the newborns whose mother with obstetrical factors should be strengthened to reduce the infection rate of GBS sepsis.