新生儿B族链球菌败血症的临床研究

Clinical study of neonatal group B streptococcal sepsis

目的探讨新生儿B族链球菌(group B streptococcus,GBS)败血症的临床特点。方法回顾江门市中心医院儿科监护室2014年1月~2019年4月诊断为GBS败血症的16例新生儿(GBS组)以及同期诊断为非GBS败血症30例新生儿(非GBS组)临床资料,分析两组一般情况、临床表现、实验室及影像学检查、住院时间、费用、抗生素应用及预后情况等。结果两组一般情况、临床症状比较差异均无统计学意义(P>0.05)。与非GBS组相比,GBS组外周血白细胞异常改变与C反应蛋白、降钙素原升高显著,差异具有统计学意义(χ~2=8.517,P=0.004;Z=4.635,P<0.001;Z=-23.56,P<0.001)。GBS组住院时间、住院费用均高于非GBS组,差异具有统计学意义(Z=-8.813,P<0.001;Z=4.165,P<0.001)。结论新生儿GBS败血症临床症状不典型,炎症指标改变显著,住院时间长、费用高。应做好预防、早期诊断,治疗首选青霉素或头孢菌素,合并脑膜炎时需选用对阳性球菌效力强的抗菌药物,必要时联合用药。

Objective To investigate the clinical features of group B streptococcus(GBS) sepsis. Methods The clinical data of 16 neonates(GBS group) diagnosed with GBS sepsis and 30 neonates with non-GBS sepsis(non-GBS group) from January 2014 to April 2019 in Jiangmen Central Hospital were reviewed. The general conditions, clinical manifestations, laboratory and imaging examinations, hospitalization time, costs, antibiotic application and prognosis between two groups were analyzed. Results There was no significant difference between the two groups in general condition and clinical symptoms(P>0.05). Compared with those of non-GBS group, abnormal changes of peripheral blood leukocytes and C-reactive protein and procalcitonin were significantly increased in GBS group, and the difference was statistically significant(χ2=8.517, P=0.004;Z=4.635, P<0.001;Z=-23.56, P<0.001). The hospitalization time and hospitalization expenses in the GBS group were higher than those in the non-GBS group, and the difference was statistically significant(Z=-8.813, P<0.001;Z=4.165, P<0.001). Conclusion The clinical symptoms of neonatal GBS sepsis are atypical,while the inflammatory index changes significantly, with long the hospital stay and high cost. Prevention and early diagnosis should be done. Penicillin or cephalosporin should be the first choice for treatment. When meningitis is combined,antibacterial drugs with strong antibiotic activity should be used. If necessary, combination therapy should be used.