新生儿化脓性脑膜炎临床表现及实验室检查特点分析

Analysis of clinical manifestations and laboratory tests characteristics of purulent meningitis in neonates

目的探讨新生儿化脓性脑膜炎的临床表现及实验室检查的特征,为临床早期诊断及合理治疗提供依据。方法对苏州大学附属儿童医院2010年1月-2016年12月期间新生儿科收治住院的186例诊断为新生儿化脓性脑膜炎患儿临床资料进行回顾性分析,根据脑脊液(cerebrospinal fluid,CSF)病原菌培养结果将患儿分为脑脊液病原菌培养阳性组(CSF培养阳性组,n=72),脑脊液病原菌培养阴性组(CSF培养阴性组,n=114)两组,分析比较两组患儿的临床资料及实验室检查结果的特点。结果CSF培养阳性组患儿平均发病日龄(16.87±9.11)d显著大于CSF培养阴性组(13.82±10.29)d,P<0.05;热峰(39.05±0.95)℃显著高于CSF培养阴性组(38.56±1.03)℃,P<0.05;热程(5.59±4.06)d长于CSF培养阴性组(3.94±3.53)d,P<0.05;CSF培养阳性组患儿凝视、惊厥症状的发生率均高于CSF培养阴性组(P<0.05);CSF培养阳性组患儿外周血C反应蛋白(CRP)、CSF白细胞计数和蛋白含量均高于阴性组,而CSF中糖含量显著低于CSF培养阴性组(均P<0.05);两组并发症及住院时间比较,CSF培养阳性组硬膜下积液、脑积水发生的比例、住院天数均高于CSF培养阴性组(P<0.05)。结论CSF病原菌培养阳性组患儿发病日龄稍大,CSF培养阳性组的化脓性脑膜炎新生儿更易出现热峰高、热程长、凝视、惊厥、外周血CRP升高、CSF白细胞计数升高、CSF蛋白水平升高、CSF糖含量下降等,且住院周期更长,头颅MRI异常发生率更高。

Objective To explore the clinical manifestations and laboratory test characteristics in neonatal purulent meningitis in order to provide the evidences for early diagnosis and appropriate treatment.Methods The clinical records of 186 neonates diagnosed with neonatal purulent meningitis and admitted to the Neonatal Department of Children’s Hospital of Soochow University from January 2010 to December 2016 were reviewed retrospectively.The patients were divided into positive cerebral spinal fluid(CSF)bacterial culture group(n=72)and negative CSF bacterial culture group(n=114)according to the results of CSF bacterial culture.The characteristics of clinical data and laboratory tests in the two groups were compared and analyzed.Results The average age of onset in the positive CSF bacterial culture group[(16.87±9.11)days]was obviously older than that of the negative CSF bacterial culture group[(13.82±10.29)days](P<0.05).The peak fever in the positive CSF bacterial culture group[(39.05±0.95)℃]was higher than that of the negative CSF bacterial culture group[(38.56±1.03)℃](P<0.05).The average fever course in the positive CSF bacterial culture group[(5.59±4.06)days]was longer than that of the negative CSF bacterial culture group[(3.94±3.53)days](P<0.05).Compared to the negative CSF bacterial culture group,neonatal patients in the positive CSF bacterial culture group had higher incidences of both gaze and seizure symptoms(P<0.05).Neonatal patients in the positive CSF bacterial culture group had higher peripheral blood C-reactive protein(CRP),higher CSF white blood cell count,higher CSF protein amount and lower CSF glucose concentration than those in the negative CSF bacterial culture group(all P<0.05).Comparison of complications and hospitalization duration between the two groups showed that the positive CSF bacterial culture group had higher incidences of subdural effusion and hydrocephalus and longer hospitalization duration than the negative CSF bacterial culture group(P<0.05).Conclusion The attack day-age is older in neonatal patients in positive CSF bacterial culture group.Neonates in the positive CSF bacterial culture group are more likely to present high peak fever,long fever process,gaze,seizure,elevated peripheral blood CRP,high CSF white blood cell count,increased CSF protein concentration and decreased CSF glucose concentration,furthermore,longer hospitalization duration and higher incidence of brain MRI abnormalities.