儿童肺炎链球菌脑膜炎120例临床分析

Clinical analysis of 120 cases of pneumococcal meningitis in children

目的探讨不同年龄组儿童肺炎链球菌脑膜炎临床特征并分析治疗后28 d死亡危险因素。方法将2017年1月—2019年12月青海省妇女儿童医院收治的120例肺炎链球菌脑膜炎患儿根据年龄分为<1岁组(80例)和≥1岁组(40例),比较两组患儿基本情况、临床表现、实验室检查结果、并发症发生情况和治疗后28 d内生存情况,并对脑脊液及血液标本分离的细菌进行药敏试验。结果80例<1岁患儿,多伴有肺炎、支气管炎等基础疾病,多表现为抽搐、嗜睡、囟门张力增高;40例≥1岁患儿,多伴有耳/鼻感染及上呼吸道感染,以呕吐、意识障碍和脑膜刺激征阳性等临床特点为主;<1岁组患儿血白细胞(WBC)>12×109/L、C反应蛋白(CRP)>50 mg/L,脑脊液中中性粒细胞升高、蛋白>1.0 g/L、糖≤1.5 mmol/L的比例显著低于≥1岁组患儿,而并发症发生率和病死率明显高于≥1岁组,以上差异均有统计学意义(P<0.05)。结论对于1岁以下发热患儿常规检查囟门,同时积极检测CRP、血WBC等有助于疾病的早期发现。

Objective To examine the clinical characteristics of pneumococcal meningitis in children of different age groups and analyze the risk factors for 28-day mortality.Methods A total of 120 children with Streptococcus pneumoniae meningitis admitted to Qinghai Women and Children's Hospital from January 2017 to December 2019 were assigned to groups by age(<1 year old,n=80;≥1 year old,n=40).The demographic data,clinical manifestations,laboratory test results,complications,and survival status within 28 days after treatment were compared between groups.Cerebrospinal fluid(CSF)and blood samples were collected for culture of pathogenic bacteria and susceptibility testing.Results Most of the 80 younger children(<1 year)were complicated with pneumonia,bronchitis,and other underlying diseases,with convulsion,drowsiness,and increased fontanelle tension.Most of the 40 children aged≥1 year were associated with ear/nose infection and upper respiratory tract infection,and clinical features of vomiting,disturbance of consciousness,and positive meningeal irritation sign.Younger children(<1 year)were associated with significantly lower prevalence of the abnormalities such as blood WBC>12×109/L,C-reactive protein(CRP)>50 mg/L,increased neutrophils in CSF,CSF protein>1.0 g/L,and CSF glucose≤1.5 mmol/L,and significantly higher incidence of complications and mortality than the older children(≥1 year)(P<0.05).Conclusions Regular examination of the fontanelle and proactive CRP and blood WBC assay are conducive to early detection of streptococcal meningitis in children with fever under 1 year old.