儿童肺炎链球菌脑膜炎死亡危险因素分析

Risk factors of mortality for children with Streptococcus pneumoniae meningitis

目的探讨儿童肺炎链球菌脑膜炎(PM)死亡的危险因素。方法回顾性分析2016年1月至2018年12月在江西省儿童医院确诊为PM的41例住院患儿的临床资料,根据预后分为死亡组10例和幸存组31例,比较两组患儿的临床特征、实验室指标及治疗的差异,通过多因素回归分析患儿死亡危险因素。结果41例PM患儿病死率24.4%。死亡组患儿抽搐、血小板<100×10^(9)/L、乳酸脱氢酶(LDH)>500 U/L、脑脊液蛋白质>3 g/L、机械通气的发生率均高于幸存组,差异有统计学意义(P<0.05)。多因素分析结果显示,LDH>500 U/L(OR=27.874,95%CI:1.253~619.966)和机械通气(OR=30.591,95%CI:1.097~853.089)是PM患儿死亡的危险因素(P<0.05)。结论PM病死率高,LDH>500 U/L、机械通气是患儿死亡的危险因素。

Objective To explore the risk factors of mortality for children with Streptococcus pneumococcal meningitis.Methods A retrospective analysis was conducted on the clinical data of 41 hospitalized children diagnosed as Streptococcus pneumoniae menigitis in Jiangxi Children's Hospital from January 2016 to December 2018.According to the prognosis of disease,the patients were divided into the death group(n=10)and the survival group(n=31).The clinical characteristics,laboratory indicators and treatment effect were compared between two groups,and the risk factors of mortality were analyzed by multivariate logistic regression analysis.Results The case fatality rate of Streptococcus pneumoniae menigitis was 24.4%.The proportions of convulsions,platelet count<100×10^(9)/L,serum lactate dehydrogenase concentration>500 U/L,cerebrospinal fluid protein level more than 3 g/L and mechanical ventilation in death group were significantly higher than those in survival group(P<0.05).The univariate analysis showed that convulsions,platelet count<100×10^(9)/L,high levels of lactate dehydrogenase(>500 U/L)and cerebrospinal fluid(>3 g/L)and undergoing mechanical ventilation were the influencing factors of the death for children with Streptococcus pneumoniae menigitis.Multivariate analysis showed that high level of lactate dehydrogenase(>500 U/L,OR=27.874,95%CI:1.253-619.966)and mechanical ventilation(OR=30.591,95%CI:1.097-853.089)were the risk factors for the death in children with PM(P<0.05).Conclusion The mortality of Streptococcus pneumoniae meningitis is high.Lactate dehydrogenase level>500 U/L and mechanical ventilation are the risk factors for death in children with Streptococcus pneumoniae menigitis.