B群链球菌感染的新生儿不同预后的临床特点分析及预测

Analysis and prediction of clinical features of different prognosis of neonates with group B streptococcal infection

目的比较B群链球菌(Group B Streptococcus,GBS)感染的新生儿不同预后的临床特点,分析导致其不良预后的危险因素,并探讨相关指标的预测价值。方法回顾性分析2013年1月至2017年12月中国医科大学附属盛京医院新生儿科收治的56例血培养为GBS感染的新生儿临床资料。根据临床转归分为存活组(n=37)和死亡组(n=19),比较两组间的临床特点及实验室结果。结果死亡组患儿的胎龄及发病日龄均小于存活组,差异均有统计学意义(P均<0.05);死亡组患儿的实验室结果C反应蛋白、脑脊液白细胞数和蛋白水平均大于存活组,差异均有统计学意义(P均<0.05)。Logistics回归多因素分析发现胎龄是GBS感染患儿死亡的独立危险因素(OR=7.56,95%CI:1.536~37.209);脑脊液蛋白及白细胞水平对患儿死亡预测的ROC曲线下面积分别为0.733(P<0.05)和0.723(P<0.05),脑脊液蛋白临界值为1.305 g/L,白细胞临界值为1 947×106/L。结论GBS感染的患儿其胎龄与预后有非常密切的关系;脑脊液蛋白及白细胞水平对患儿死亡风险的发生有预测价值。

Objective To analyze the risk factors leading to poor prognosis and to explore the predictive value of related indicators by comparing the clinical features of different prognosis of neonates infected with Group B Streptococcus (GBS). Methods A retrospective study was performed on the clinical data of 56 neonates with GBS infection in blood culture admitted to Shengjing Hospital of China Medical University from January 2013 to December 2017.According to the clinical outcomes, the neonates were divided into survival group (n=37) and death group (n=19). The clinical characteristics and laboratory results between the two groups were analyzed and compared. Results The gestational age and age of onset in the death group were younger than those in the survival group, the differences were statistically significant (P<0.05). The C-reactive protein and cerebrospinal fluid leukocyte count and protein in the death group were higher than those in the survival group, and the differences were statistically significant (P<0.05). Logistic regression multivariate analysis found that gestational age was an independent risk factor for the death of neonates infected with GBS(OR=7.56, 95%CI: 1.536~37.209). The area under the ROC curve for cerebrospinal fluid protein and white blood cell levels predicting death in children was 0.733 (P<0.05) and 0.723 (P<0.05), respectively, and the cerebrospinal fluid protein threshold was 1.305 g/L, the threshold value of white blood cells was 1 947×106/L. Conclusion The gestational age of children with GBS infection has a very close relationship with the prognosis;cerebrospinal fluid protein and white blood cell levels have predictive value for the risk of death in children.