儿童细菌性脑膜炎并发硬膜下积液的临床特征及危险因素分析

Clinical features and risk factors of subdural effusion in children with bacterial meningitis

目的探讨儿童细菌性脑膜炎(BM)并发硬膜下积液(SE)的临床特征,并分析相关危险因素。方法回顾性分析2017年1月至2019年1月在广西壮族自治区妇幼保健院儿童神经内科住院且诊断为BM的患儿102例,其中男63例,女39例;年龄1个月~11岁,中位年龄5个月。根据头颅MRI检查是否合并SE,将患儿分为BM并发SE组和未并发SE组,比较两组患儿的一般资料、血液学及脑脊液检查结果,采用多因素logistic回归分析BM并发SE的危险因素。结果BM患儿并发SE 23例,发生率为22.5%。两组患儿年龄、惊厥、外周血CRP水平、脑脊液蛋白及葡萄糖水平比较差异均有统计学意义(均P<0.05),多因素logistic回归分析显示惊厥(OR=19.314,95%CI:1.858~200.747,P=0.013)、脑脊液葡萄糖水平降低(OR=0.186,95%CI:0.035~0.984,P=0.048)均是儿童BM并发SE的独立危险因素。结论惊厥发作、脑脊液葡萄糖水平降低与BM患儿并发SE有关,早期识别是否合并SE有助于正确判断病情,指导合理用药和调整治疗方案。

Objective To analyze the clinical features of subdural effusion(SE)and its risk factors in children with bacterial meningitis(BM).Methods The clinical data of 102 children with BM admitted in Department of Pediatric Neurology of Guangxi Zhuang Autonomous Region Maternal and Child Health Hospital from January 2017 to January 2019 were retrospectively analyzed.There were 63 males and 39 females with a median age of 5 months(1 month to 11 years).According to whether there was SE combined in the cranial MRI examination,the children were divided into the BM with SE group and the non-SE group.The general data,hematology and cerebrospinal fluid(CSF)examination results were compared between the BM with SE group and the non-SE group,and the risk factors of SE were analyzed by multivariate logistic regression.Results There were significant differences in age,convulsion,CRP level,protein and glucose contents in CSF between the two groups(all P<0.05).Multivariate logistic regression analysis showed convulsion(OR=19.314,95%CI:1.858-200.747,P=0.013)and CSF glucose level(OR=0.186,95%CI:0.035-0.984,P=0.048)were independent risk factors for SE in children with BM.Conclusion Convulsion seizure and low level of CSF glucose are associated with SE in children with BM.Early identification of SE is helpful to correctly judge the disease,guide rational drug use and adjust the treatment plan.