儿童结核性脑膜炎合并营养不良的临床特征及与短期转归的关系

Clinical characteristics of tuberculous meningitis children with malnutrition and their relationships with short-term outcomes

目的探讨儿童结核性脑膜炎(TBM)合并营养不良的临床特征及与TBM短期转归的关系。方法回顾性选取2016年2月至2022年4月广州市胸科医院儿科收治的80例TBM患儿作为研究对象,根据营养不良诊断标准将患儿分为营养不良组(66例)和非营养不良组(14例)。营养不良组男35例,女31例;1月龄~<1岁6例,1~<3岁19例,3~<6岁11例,6~<18岁30例;生活环境:村镇64例,城市2例。非营养不良组男9例,女5例;1月龄~<1岁1例,1~<3岁3例,3~<6岁2例,6~<18岁8例;生活环境:村镇7例,城市7例。对比分析两组临床特征及与短期转归的关系。采用χ^(2)检验和Fisher确切概率法。结果在80例TBM患儿中,82.5%(66/80)合并营养不良,71.2%(57/80)合并贫血,51.2%(41/80)合并低蛋白血症。营养不良组居住在村镇[97.0%(64/66)]、病程>14 d[81.2%(52/66)]的比例高于非营养不良组[50.0%(7/14)、35.7%(5/14)](均P<0.05)。营养不良组贫血[77.2%(51/66)]、低蛋白血症[57.6%(38/66)]、药物性肝损伤[51.5%(34/66)]、后遗症发生率[48.5%(32/66)]和出院时脑脊液异常率[60.6%(40/66)]均高于非营养不良组[42.8%(6/14)、21.4%(3/14)、21.4%(3/14)、14.3%(2/14)、35.7%(5/14)](均P<0.05)。两组临床分期、脑积水、脊髓病灶、病死率比较,差异均无统计学意义(均P>0.05)。结论TBM患儿易合并营养不良,营养不良的TBM患儿易出现短期转归不良,有必要尽早对TBM患儿进行营养风险筛查及营养支持治疗。

Objective To investigate the clinical characteristics of malnutrition in children with tuberculous meningitis(TBM)and their relationships with short-term TBM outcomes.Methods A total of 80 TBM children admitted to the Department of Pediatrics,Guangzhou Chest Hospital from February 2016 to April 2022 were retrospectively selected as the study objects.According to the diagnostic criteria for malnutrition,the children were divided into a malnutrition group(66 cases)and a non-malnutrition group(14 cases).There were 35 boys and 31 girls in the malnutrition group;6 casesaged 1 month-<1 year,19 casesaged 1-<3 years,11 casesaged 3-<6 years,and 30 cases aged 6-<18 years;64 cases lived in villages and towns,and 2 cases in cities.There were 9 boys and 5 girls in the non-malnutrition group;1 case aged 1 month-<1 year,3 cases aged 1-<3 years,2 cases aged 3-<6 years,and 8 cases aged 6-<18 years;7 cases lived in villages and towns,and 7 cases in cities.The clinical characteristics of the two groups and their relationships with short-term outcomes were compared.χ^(2) test and Fisher exact probability method were used.Results Among the 80 children with TBM,82.5%(66/80)were complicated with malnutrition,71.2%(57/80)with anemia,and 51.2%(41/80)with hypoalbuminemia.The proportions of the malnutrition group living in villages and towns[97.0%(64/66)]and with disease course>14 days[81.2%(52/66)]were higher than those of the non-malnutrition group[50.0%(7/14)and 35.7%(5/14)](both P<0.05).The incidences of anemia[77.2%(51/66)],hypoalbuminemia[57.6%(38/66)],drug-induced liver injury[51.5%(34/66)],sequelae[48.5%(32/66)],and abnormal cerebrospinal fluid findings at discharge[60.6%(40/66)]in the malnutrition group were all higher than those in the non-malnutrition group[42.8%(6/14),21.4%(3/14),21.4%(3/14),14.3%(2/14),and 35.7%(5/14)](all P<0.05).There was no statistically significant difference in the clinical stage,hydrocephalus,spinal cord lesions,or mortality between the two groups(all P>0.05).Conclusions Malnutrition is prevalent among children with TBM,and is associated with worse short-term outcomes.Early identification of nutritional risks and prompt nutritional support are essential in managing TBM in children.