新生儿化脓性脑膜炎近期预后不良原因分析

Causes analysis of short-term poor prognosis of neonatal purulent meningitis

目的探讨新生儿化脓性脑膜炎近期预后不良的危险因素。方法回顾性分析2015年9月至2021年1月于河北省人民医院新生儿科诊治的76例新生儿化脓性脑膜炎患儿的相关临床资料,根据其6~12个月内转归分为预后良好组(n=46)和预后不良组(n=30),比较两组新生儿的一般情况、出生史、临床特点、实验室检测结果及病原菌类别等情况,采用多因素Logistic回归分析近期预后不良的因素,并通过绘制ROC曲线评估各个指标对于预后预测的效能。结果预后不良组患儿男婴占比(23/30,76.67%)、低出生胎龄比例(13/30,43.33%)、低出生体重(8/30,26.67%)、合并意识障碍比例(13/30,43.33%)、电解质异常比例(9/30,30.00%)较预后良好组高[52.17%(24/46)、2.17%(1/46)、2.17%(1/46)、21.74%(10/46)、2.17%(1/46)],两组比较均差异有统计学意义(χ^(2)=4.62,4.01,9.99;均P<0.05)。预后不良组患儿脑脊液(CSF)白细胞计数[435(165,875)×10^(6)/L]、CSF蛋白水平[1.54(0.90,2.38)g/L]均高于预后良好组[78(32,305)×10^(6)/L,0.70(0.57,1.02)g/L],CSF葡萄糖/血糖比值[0.37(0.27,0.53)]低于预后良好组[0.54(0.46,0.68)],两组比较均差异有统计学意义(Z=-3.78,-4.72,-3.26;均P<0.01)。Logistic回归分析显示,CSF白细胞计数、CSF蛋白水平、CSF葡萄糖/血糖比值是提示预后不良的危险因素(OR=1.002,2.840,0.056;均P<0.05)。ROC曲线显示,CSF白细胞计数、CSF蛋白水平、CSF葡萄糖/血糖比值及三者联合模型曲线下面积(AUC)分别为0.800,0.822,0.769,0.879。结论CSF白细胞计数高、CSF葡萄糖/血糖比值低、CSF蛋白水平高是提示新生儿化脓性脑膜炎近期预后不良的独立危险因素。

Objective To investigate the risk factors of short-term poor prognosis of neonatal purulent meningitis.MethodsThe clinical data of 76 cases of neonatal purulent meningitis treated in the Neonatology Department of Hebei Provincial People′s Hospital from September 2015 to January 2021 were retrospectively analyzed.According to their outcomes of 6-12 months,they were divided into the good prognosis group(n=46)and the poor prognosis group(n=30).The newborn′s general situation,birth history,clinical features,laboratory examination results and pathogenic species were compared between the two groups.Multivariable logistic regression was used to analyze the factors associated with poor outcome,and the ROC curve to assess the effectiveness of each index in predicting prognosis.ResultsIn the poor prognosis group,the proportion of male(23/30,76.67%),the proportion of low gestational age(13/30,43.33%),the proportion of low birth weight(8/30,26.67%),the proportion of complicated with consciousness disorder(13/30,43.33%),and the proportion of electrolyte abnormalities(9/30,30.00%)were higher than those in the good prognosis group[52.17%(24/46),2.17%(1/46),2.17%(1/46),21.74%(10/46),2.17%(1/46)],the differences between the two groups were statistically significant(χ^(2)=4.62,4.01,9.99,all P<0.05).The CSF white blood cell count[435(165,875)×10^(6)/L]and CSF protein level[1.54(0.90,2.38)g/L]in the poor prognosis group were higher than those in the good prognosis group[78(32,305)×10^(6)/L,0.70(0.57,1.02)g/L],and the CSF glucose/blood glucose ratio[0.37(0.27,0.53)]was lower than that in the good prognosis group[0.54(0.46,0.68)].The differences between the two groups were statistically significant(Z=-3.78,-4.72,-3.26,all P<0.01).Logistic regression analysis showed that CSF white blood cell count,CSF protein level and CSF glucose/blood glucose ratio were risk factors for poor prognosis(OR=1.002,2.840,0.056;all P<0.05).The ROC curve showed that area under the curve(AUC)of CSF white blood cell count,CSF protein level,CSF glucose/blood glucose ratio,and the combined model were 0.800,0.822,0.769,and 0.879,respectively.ConclusionHigh CSF white blood cell count,low CSF glucose/blood glucose ratio and high CSF protein level are independent risk factors for short-term poor prognosis of neonatal purulent meningitis.