不同年龄组小儿肺炎链球菌性脑膜炎临床特征及预后影响因素调查

Clinical characteristics and prognostic factors of pneumococcal meningitis in different age groups

目的探讨不同年龄组小儿肺炎链球菌性脑膜炎临床特征及预后影响因素。方法采用回顾性分析,收集医院2015-06至2016-06住院治疗的经病原学检测确诊为肺炎链球菌性脑膜炎的124例患儿完整病历资料,根据年龄分为<1岁组、1~5岁组、>5岁组,比较3组患儿的临床特征;根据Glasgow预后评分分为预后良好组和预后不良组,采用单因素和Logistic回归分析患儿的预后影响因素。结果 124例患儿均出现不同程度的发热。<1岁组患儿囟门张力高和惊厥发生率明显高于1~5岁组、>5岁组患儿(均P<0.05);1~5岁组患儿昏迷、意识模糊发生率明显高于其他两组患儿(P<0.05),>5岁组患儿头痛、呕吐发生率明显高于另外两组(P<0.05);<1岁组并发症发生率为91.2%(73/80),1~5岁组并发症发生率为65.2%(15/23),>5岁组并发症发生率为28.6%(6/21)。<1岁组并发症发生率明显高于1~5岁组和>5岁组(χ2=9.730,38.355,均P<0.05);Logistic回归分析显示:年龄小于1岁、C反应蛋白升高、脑脊液糖降低、血钠降低、血钙降低、血清蛋白降低等是肺炎链球菌性脑膜炎预后的独立影响因素。结论本病好发于1岁以下的男性儿童,年龄<1岁、C反应蛋白>100 mg/L、低血钠血症、低血钙是本病预后的影响因素。

Objective To explore the clinical characteristics and prognostic factors of pneumococcal meningitis in different age groups. Methods The clinical data on 124 patients with pneumococcal meningitis who had been hospitalized in our hospital and confirmed by pathology between June 2015 and June 2016 was retrospectively analyzed. These patients were divided into three groups：Group A(under one year old）,Group B(1 to 5 years old） and Group C(above 5 years old）. The clinical characteristics of the three groups were compared. According to the Glasgow prognosis score,the prognostic factors of these children were analyzed by single factor and logistic regression analysis. Results All the 124 cases showed different degrees of fever. The incidence of high fontanelle tension and convulsion in Group A was significantly higher than that in the other groups. The incidence of coma and fuzzy consciousness in Group B was significantly higher than that in the other two groups(P 〈 0. 05）,and the incidence of headache and vomiting was significantly higher in Group C than in the other two groups(P 〈 0. 05）. The incidence of complications was 91. 2%(73/80） in Group A,65. 2%(15/23） in Group B and 28. 6%(6/21） in Group C. The incidence of complications was significantly higher in Group A than in the other two groups. Logistic regression analysis showed that age less than 1 year old,elevated c-reactive protein,and lower levels of cerebrospinal fluid glucose,blood sodium,blood calcium,and serum protein were independent factors that affected the prognosis of pneumococcal meningitis. Conclusions Boys under one year old are more vulnerable to pneumococcal meningitis. Age under one year old,c-reactive protein above 100 mg/L,hyponatremia,and low blood calcium are the factors affecting the prognosis of the disease.