新生儿B族链球菌感染性化脓性脑膜炎的临床特征及预后分析

Clinical Characteristics and Prognosis of Neonatal Purulent Meningitis Caused by Group B Streptococcal Infection

目的分析新生儿B族链球菌(GBS)感染性化脓性脑膜炎的临床特征及预后。方法选取2010—2016年深圳市妇幼保健院收治的新生儿GBS感染性化脓性脑膜炎患儿28例作为观察组,新生儿非GBS感染性化脓性脑膜炎患儿19例作为对照组。两组患儿均予以哌拉西林他唑巴坦联合头孢曲松治疗。比较两组患儿临床表现,实验室检查指标,颅脑磁共振成像(MRI)检查结果,血白细胞计数、血C反应蛋白、脑脊液糖含量、脑脊液乳酸脱氢酶含量恢复正常时间及住院时间,预后。结果 (1)两组患儿发热、黄疸、激惹、前囟张力增高、反应差、肤色差/花纹、颈项强直、肌张力增高、食欲不振、四肢抽动、呼吸急促、凝视发生率比较,差异无统计学意义(P>0.05)。(2)观察组患儿血白细胞计数、血C反应蛋白、血降钙素原、脑脊液乳酸脱氢酶含量高于对照组,脑脊液糖含量低于对照组(P<0.05);两组患儿血糖比较,差异无统计学意义(P>0.05)。(3)观察组患儿颅脑MRI检查结果异常率高于对照组(P<0.05)。(4)观察组患儿血白细胞计数、血C反应蛋白、脑脊液糖含量、脑脊液乳酸脱氢酶含量恢复正常时间及住院时间长于对照组(P<0.05)。(5)两组患者随访2个月～3.5年,平均随访(1.98±0.02)年;两组患儿预后不良发生率比较,差异无统计学意义(P>0.05)。结论新生儿GBS感染性化脓性脑膜炎主要临床表现包括发热、黄疸、激惹及反应差等,但临床表现缺乏特异性,神经系统并发症发生风险较高,治疗效果及预后较差,应合理进行产前GBS筛查以减少新生儿GBS感染性化脓性脑膜炎的发生。

Objective To analyze the clinical characteristics and prognosis of neonatal purulent meningitis caused by group B streptococcal(GBS)infection.Methods From January 2010 to December 2016 in Maternal and Child Care Service Center of Shenzhen,28 neonates with purulent meningitis caused by GBS infection were selected as observation group,19 neonates with purulent meningitis caused by non-GBS infection were selected as control group,all of them were treated with piperacillin/tazobactam combined with cefatriaxone.Clinical manifestations,laboratory examination results,craniocerebral MRI examination results,time for returning to normal of blood WBC,blood CRP,glucose content and LDH in cerebrospinal fluid,hospital stays and prognosis were compared between the two groups.Results (1)No statistically significant difference of incidence of fever,jaundice,irritability,increased anterior fontanel tension,poor response,poor complexion/patterns on the skin surface,neck rigidity,hypermyotonia,loss of appetite,limb spasms,ecphysesis or gaze was found between the two groups(P>0.05).(2)Blood WBC,blood CRP,blood PCT and CSF in cerebrospinal fluid in observation group were statistically significantly higher than those in control group,while glucose content in cerebrospinal fluid in observation group was statistically significantly lower than that in control group(P<0.05);no statistically significant difference of blood glucose was found between the two groups(P>0.05).(3)Abnormality ratio of craniocerebral MRI examination results in observation group was statistically significantly higher than that in control group(P<0.05).(4)Time for returning to normal of blood WBC,blood CRP,glucose content and LDH in cerebrospinal fluid,and hospital stays in observation group were statistically significantly longer than those in control group(P<0.05).(5)During the follow-up that ranged from 2 months to 3.5 years〔average(1.98±0.02)years〕,no statistically significant difference of poor prognosis was found between the two groups(P>0.05).Conclusion Purulent meningitis caused by GBS infection in neonatal period is mainly manifested by fever,jaundice,irritability,poor response and so on,but it is lack of specificity and may lead to increased risk of neurological complications,the prognosis is generally poor due to unsatisfactory treatment response;therefore,prenatal screening test for GBS should be conducted in a reasonable way to reduce the incidence of neonatal purulent meningitis caused by GBS infection.