新生儿大肠埃希菌感染致细菌性脑膜炎脑脊液和并发症特点

Characteristics of cerebrospinal fluid and complications of bacterial meningitis caused by Escherichia coli infection in neonates

目的探讨大肠埃希菌(E.coli)感染所致新生儿细菌性脑膜炎(BM)脑脊液(CSF)和并发症的特点。方法选择2018年1月至2019年12月西北妇女儿童医院新生儿科住院的BM患儿108例,根据腰椎穿刺CSF培养结果分为三组,即E.coli组(n=20)、其他细菌组(n=40)和病原菌不明组(n=48),回顾性分析并比较三组患儿的CSF特点和并发症情况等。结果其他细菌组及病原菌不明组患者脑脊液清亮度优于E.coli组(F=33.03,P<0.05);E.coli组患者脑脊液白细胞计数和蛋白含量均高于其他细菌组和病原菌不明组,而糖含量低于其他两组(F值分别为35.197、1.972、60.204,均P<0.05);E.coli组患者脑脊液恢复正常需要的时间、发热持续时间以及患儿住院时间均长于其他细菌组与病原菌不明组(F值分别为480.253、32.864、207.784,均P<0.05);E.coli组患者新生儿惊厥、脑室管膜炎及脑脓肿发生率高于其他细菌组和病原菌不明组(χ^2值分别为12.59、19.58,均P<0.05),而听力及视觉损害、脑室扩大及白质损伤方面差异无统计学意义(均P>0.05);E.coli组患者病死率高于其他细菌组和病原菌不明组,差异有统计学意义(χ^2=9.352,P<0.05)。结论 E.coli感染致新生儿BM临床症状重且持续时间长、CSF异常显著、住院时间长且并发症多、病死率高,应引起临床医师高度重视。

Objective To investigate the characteristics of cerebrospinal fluid(CSF) and complications of neonatal bacterial meningitis(BM) caused by E.coli infection.Methods 108 children with BM admitted to the department of pediatrics of Northwest Women’s and Children’s Hospital from January 2018 to December 2019 were selected and divided into three groups according to the culture results of lumbar puncture CSF,namely E.coli group(n=20),other bacteria group(n=40) and pathogen unknown group(n=48).CSF characteristics and complications of children in the three groups were retrospectively analyzed and compared.Results The CSF clear brightness of patients in other bacterial group and pathogen unknown group was better than that in E.coli group(F=33.03,P<0.05).The content of CSF white blood cell count and protein in E.coli group were higher than those in other bacteria group and pathogen unknown group,while the content of sugar was lower than that in other two groups(F values were 35.197,1.972 and 60.204,respectively,all P<0.05).The time required for the recovery of CSF,the duration of fever and the hospitalization time of the patients in the E.coli group were longer than those in the other bacteria group and the pathogen unknown group(F values were 480.253,32.864 and 207.784,respectively,all P<0.05).The incidence of neonatal convulsion,ependymitis and brain abscess in E.coli group was higher than those in other bacterial group and unknown pathogen group(χ^2=12.59 and 19.58,respectively,both P<0.05).However,there was no statistically significant difference in terms of hearing and visual impairment,ventricular enlargement and white matter damage(all P>0.05).The case fatality rate of E.coli group was higher than that of other bacterial group and unknown pathogen group,and the difference was statistically significant(χ^2=9.352,P<0.05).Conclusion The clinical symptoms of BM in neonates caused by E.coli infection were severe and lasted for a long time,CSF was abnormal,hospital stay was long,complications were frequent,and mortality was high,which should be paid great attention by clinicians.