临床儿科杂志 ›› 2020, Vol. 38 ›› Issue (2): 104-.doi: 10.3969/j.issn.1000-3606.2020.02.007

• 综合报道 • 上一篇    下一篇

新生儿化脓性脑膜炎并发脑白质损伤危险因素分析

王海如, 秦梓健, 王斌, 欧阳学军   

  1. 南方医科大学珠江医院儿科中心 广州市炎症与免疫性疾病重点实验室(广东广州 510280)
  • 发布日期:2020-02-20
  • 通讯作者: 王斌 电子信箱:wangbin6556@126.com

Risk factors of neonatal purulent meningitis complicated with white matter damage

 WANG Hairu,QIN Zijian, WANG Bin,OUYANG Xuejun   

  1. Department of Pediatrics,Zhujiang Hospital,Southern Medical University,Guangzhou Key Laboratory of Inflammation and Immune Diseases,Guangzhou 510282,Guangdong, China
  • Published:2020-02-20

摘要: 目的 探讨新生儿化脓性脑膜炎并发脑白质损伤(WMD)的临床特点及高危因素。方法 回顾分析2008年 1月至2018年1月收治的诊断为新生儿化脓性脑膜炎的足月新生儿的临床资料。结果 170例足月化脓性脑膜炎新生儿 中,32例(18.82%)合并WMD(WMD组),其中男20例、女12例,平均胎龄(38.71±1.14)周,出生体质量(2.94±0.26) kg;另138例患儿未并发WMD(对照组),男80例、女58例,平均胎龄(38.62±1.04)周,出生体质量(2.97±0.25)kg。 两组患儿性别、胎龄、出生体质量的差异无统计学意义(P>0.05)。170例患儿中60例(35.29%)明确细菌病原学诊断,其 中革兰阴性杆菌25例、革兰阳性球菌35例。WMD组的洋葱伯克霍菌阳性率高于对照组,差异有统计学意义(P<0.05)。 两组间革兰阳性球菌及阴性杆菌的阳性率差异无统计学意义(P>0.05)。WMD组同年龄组异常脑电图以及听力损害发生 率均高于对照组,差异有统计学意义(P<0.05)。 惊厥(OR=5.28,95%CI:1.80~15.56)、脑脊液白细胞升高(OR=4.22, 95%CI:1.47~12.07)、脑脊液乳酸脱氢酶升高(OR=3.64,95%CI:1.11~11.99)、细菌培养阳性(OR=3.12,95%CI:1.13~8.62) 为足月新生儿化脓性脑膜炎并发WMD的独立危险因素。ROC曲线显示,脑脊液白细胞(AUC=0.707)、脑脊液乳酸脱氢 酶(AUC=0.672)对于预测化脓性脑膜炎并发WMD有一定准确性。结论 新生儿化脓性脑膜炎惊厥表现,脑脊液白细胞、 乳酸脱氢酶升高可能为并发WMD的高危因素。

关键词: 化脓性脑膜炎; 脑白质损伤; 新生儿

Abstract: Objective To investigate the clinical features and risk factors of white matter damage (WMD) in neonatal purulent meningitis. Methods A total of 170 cased of full-term neonates with purulent meningitis hospitalized in the NICU between January 2008 to January 2018 were retrospectively enrolled in the study. Clinical data were retrospectively analyzed by univariate and logistic multivariate regression analysis. Results Of the 170 full-term neonates enrolled, 32 cases were combined with WMD (case group), and the remaining 138 cases were concurrent with no WMD (control group). There were 17 cases of WMD had a confirmed bacterial etiology, and the most common of which are Group B beta-hemolytic streptococcus (GBS) (n=6) and Escherichia coli (n=4). There was no significant difference between Gram positive cocci and Gram negative bacilli in concurrent WMD (P < 0.05). There were significant differences between GBS and Burkholderia cepacia in concurrent WMD (P < 0.05). A total of 8 cases (25%) had EEG abnormalities in neonates with WMD, and 16 cases (50%) had hearing impairment. The incidence of EEG abnormalities and hearing impairment increased significantly (P<0.01). The univariate analysis showed the factors related with WMD were as follows: convulsion, altered level of consciousness, bulging fontanel, CRP>100 mg/L, Cerebrospinal fluid composition change (CSF-WBC> 500×106/L、CSF-LDH>300 U/L、CSF-Pro>2.0 g/L,CSF-Glu<1.1 mmol/L) and positive bacterial culture (all P<0.05). According to the logistic multivariate regression analysis, convulsion (OR=5.284), CSF-WBC (OR=4.218) ), CSF-LDH (OR=3.634), positive bacterial culture (OR=3.123) were high risk factors for WMD in neonatal purulent meningitis. ROC curve analysis showed that CSF-WBC, CSF-LDH were effective predictors for WMD, with the area under ROC curve were 0.707, 0.672, respectively. Conclusion Neonatal purulent meningitis complicated with severe manifestations, and prematurity and abnormal laboratory indicators were high risk factors for WMD, which should be highly vigilant in clinical practice, and active treatment should be given.

Key words:  purulent meningitis; white matter damage; neonate