早期头颅磁共振成像联合脑脊液指标预测足月儿细菌性脑膜炎预后的价值

Value of early brain MR combined with CSF parameters for predicting the outcomes of full-term neonatal bacterial meningitis

目的探讨早期头颅MR联合脑脊液指标预测足月新生儿细菌性脑膜炎预后的价值。方法回顾性队列研究。以住院的细菌性脑膜炎足月儿为研究对象,设出院结局为队列终点(预后良好组和预后不良组),以早期头颅MR半定量评分系统和/或脑脊液检查(WBC数、蛋白、葡萄糖)为预测指标,评估不同方法预测足月新生儿细菌性脑膜炎预后的价值。结果符合本研究纳入和排除标准的189例细菌性脑膜炎足月儿纳入分析,男108例(57.1%)、出生胎龄37~42.3周、出生体重2100~5000 g、经阴道分娩132例(69.8%)、发病日龄1~28 d、住院天数4~129 d。预后良好和预后不良组分别为162例(85.7%)和27例(14.3%),2组患儿出生胎龄、出生体重、性别、分娩方式、发病日龄和发病至头颅MR检查时间差异均无统计学意义。头颅MR和脑脊液指标预测足月新生儿细菌性脑膜炎预后的ROC曲线下面积(AUC)由大到小依次是头颅MR评分+脑脊液蛋白(0.9024)、头颅MR评分(0.8752)、脑脊液蛋白(0.7876)、脑脊液WBC数(0.7284)、脑脊液葡萄糖(0.2479)。头颅MR评分的诊断界值为17分、脑脊液蛋白的诊断界值为2316 mg·L^-1时,头颅MR评分与脑脊液蛋白AUC差异无统计学意义;头颅MR评分+脑脊液蛋白与脑脊液蛋白AUC差异有统计学意义,与头颅MR评分差异无统计学意义。头颅MR评分+脑脊液蛋白和头颅MR评分的敏感度分别为88.9%(95%CI:84.4%~93.4%)和77.8%(95%CI:71.9%~83.7%),特异度分别为80.9%(95%CI:75.3%~86.5%)和82.7%(95%CI:77.3%~88.1%)。结论早期头颅MR评分联合脑脊液蛋白,提高了预测足月新生儿细菌性脑膜炎预后的准确性。

Objective To investigate the value of early brain MR combined with cerebrospinal fluid( CSF) parameters in predicting the outcomes of full-term neonatal bacterial meningitis. Methods A retrospective cohort study analyzed hospitalized fullterm infants with bacterial meningitis,using the discharge outcomes as the cohort endpoint( good prognosis group and poor prognosis group),and early brain MR semi-quantitative scoring system and/or CSF examination( CSF white blood cells,CSF protein,CSF glucose) as predictive indicators,to evaluate the value of different methods in predicting the outcomes of full-term neonatal bacterial meningitis. Results One hundred and eighty-nine full-term infants with bacterial meningitis who met the inclusion and exclusion criteria of this study were included in our analysis. Among them,108( 57.1%) were male;the gestational age ranged from 37 to 42.3 weeks;the birth weight was 2,100 ~ 5,000 g;132( 69.8%) were delivered vaginally;the age of onset was from 1 to 28 d;the hospitalization stay was 4 ~ 129 d. There were 162( 85.7%) and 27( 14.3%) cases in the good and poor prognosis groups respectively and there were no statistically significant differences in gestational age,birth weight,gender,delivery method,age of onset and brain MR examination time between the two groups. The area under curve( AUC) of the combination of brain MR scores and CSF protein,brain MR scores,CSF protein,CSF white blood cells,CSF glucose was 0.902,0.875,0.788,0.728,0.248,respectively. The cut-off value of brain MR scores was 17 points,and that of CSF protein was 2,316 mg·L-1. There was no statistically significant difference in AUC between the brain MR scores and CSF protein,and the difference between the combination indicator and CSF protein was statistically significant,but there was no statistically significant difference between the combination indicator and brain MR scores. Sensitivity and specificity of the combination indicator with brain MR scores were 88.9%( 95%CI: 84.4%~93.4%) vs 77.8%( 95%CI: 71.9%~83.7%),80.9%( 95%CI: 75.3%~86.5%) vs 82.7%( 95%CI: 77.3%~88.1%),respectively. Conclusion The combination of early brain MR scores and CSF protein improved the accuracy of predicting the prognosis outcomes of full-term neonatal bacterial meningitis.