基于临床和MRI特征的足月新生儿化脓性脑膜炎神经系统不良预后高危因素分析

Analyses of high-risk factors for poor neurologic prognosis in full-term neonatal purulent meningitis based on clinical and MRI characteristics

目的基于临床和颅脑MRI特征探讨足月新生儿化脓性脑膜炎神经系统不良预后的高危因素。方法本研究为病例对照研究,回顾性收集2016年1月至2022年1月首都医科大学附属北京儿童医院收治的79例新生儿化脓性脑膜炎患儿的临床及颅脑MRI资料。随访患儿生长发育情况、神经系统后遗症等,最短随访时间6个月。根据随访结果分为预后良好组(49例)和预后不良组(30例)。采用χ2检验比较2组患儿的临床和颅脑MRI特征,采用多因素logistic回归分析获得足月新生儿化脓性脑膜炎神经系统不良预后的高危因素。结果临床资料中,预后不良组与预后良好组患儿间惊厥、早发型、脑脊液病原菌培养阳性比例、脑脊液白细胞计数及脑脊液蛋白含量差异有统计学意义(P<0.05)。MRI特征中,预后不良组与预后良好组患儿间室管膜炎、脑室明显扩张/脑积水、点片状脑损伤/出血灶及脑实质内破坏性病变的发生率差异有统计学意义(P<0.05)。多因素logistic回归分析结果表明,惊厥(OR=5.722,95%CI 1.126~29.072,P=0.035)、早发型新生儿化脓性脑膜炎(OR=3.657,95%CI 1.073~12.459,P=0.038)、室管膜炎(OR=8.851,95%CI 1.169~67.017,P=0.035)、脑室明显扩张/脑积水(OR=12.675,95%CI 1.085~148.110,P=0.043)及脑实质内破坏性病变(OR=16.370,95%CI 1.575~170.175,P=0.019)是影响患儿预后的独立危险因素。结论足月新生儿化脓性脑膜炎病程中出现惊厥、早发型病变以及MRI表现为室管膜炎、脑室明显扩张/脑积水和脑实质内破坏性病变是不良预后的高危因素。

Objective To analyze high-risk factors for poor neurological prognosis in full-term neonatal purulent meningitis based on clinical and brain MRI features.Methods This study was a case-control study.The clinical and brain MRI data of 79 neonates with purulent meningitis were retrospectively collected at Beijing Children′s Hospital,Capital Medical University from January 2016 to January 2022.Follow-up assessments including growth and development,as well as neurological sequelae,were conducted over a minimum follow-up period of 6 months.The patients were divided into two groups with good(n=49)and poor prognosis(n=30)according to follow-up results.Chi-square tests were used to compare clinical and brain MRI features between the two groups,and a multivariate logistic regression analysis was performed to explore the high-risk factors for poor neurologic prognosis in full-term neonates with purulent meningitis.Results There were statistically differences between two groups regarding the incidence of seizures,early-onset manifestations,positive cerebrospinal fluid(CSF)culture,CSF white cell counts,and CSF protein concentration(P<0.05).Statistically differences were also found in the occurrence rates of ependymitis,obvious ventricular dilatation/hydrocephalus,spotty and patchy brain injury/hemorrhage,and destructive lesions within the brain parenchyma(P<0.05).The results of multivariate logistic regression analysis indicated that seizures(OR=5.722,95%CI 1.126-29.072,P=0.035),early-onset neonatal purulent meningitis(OR=3.657,95%CI 1.073-12.459,P=0.038),ependymitis(OR=8.851,95%CI 1.169-67.017,P=0.035),obvious ventricular dilatation/hydrocephalus(OR=12.675,95%CI 1.085-148.110,P=0.043),and destructive lesions within the brain parenchyma(OR=16.370,95%CI 1.575-170.175,P=0.019)were independent risk factors for poor prognosis.Conclusions The occurrence of seizures,early-onset manifestations as well as ependymitis,obvious ventricular dilatation/hydrocephalus,and destructive lesions within the brain parenchyma on MRI are high-risk factors for poor prognosis in the full-term neonate with purulent meningitis.