新生儿细菌性脑膜炎预后不良的危险因素分析

Risk factors for poor prognosis of neonatal bacterial meningitis

摘要:

目的 探讨新生儿细菌性脑膜炎预后不良的危险因素。方法 回顾性分析152例细菌性脑膜炎新生儿的临床资料，根据转归分为预后良好组（n=122）与预后不良组（n=30），比较两组患儿的一般情况、首发症状及实验室检查结果，分析预后不良的危险因素。结果 预后不良组极低出生体重、外周血WBC < 5×10⁹/L或 > 20×10⁹/L、C-反应蛋白 > 50 mg/L、脑脊液WBC > 500×10⁶/L、脑脊液糖 < 1 mmol/L、脑脊液蛋白 > 2 g/L比例高于预后良好组（P < 0.05），血培养和/或脑脊液培养阳性率、革兰阳性菌及无乳链球菌培养阳性率高于预后良好组（P < 0.05）。多因素logistic回归分析显示，脑脊液糖 < 1 mmol/L、脑脊液蛋白 > 2 g/L是新生儿细菌性脑膜炎预后不良的独立危险因素。结论 脑脊液糖 < 1 mmol/L、脑脊液蛋白 > 2 g/L是新生儿细菌性脑膜炎预后不良的危险因素。

Abstract:

Objective To investigate the risk factors for poor prognosis of neonatal bacterial meningitis. Methods A retrospective analysis was performed for the clinical data of 152 children with neonatal bacterial meningitis. According to their prognosis, they were divided into a good prognosis group with 122 children and a poor prognosis group with 30 children. The two groups were compared in terms of general status, initial symptoms, and laboratory findings, and the risk factors for poor prognosis were analyzed. Results Compared with the good prognosis group, the poor prognosis group had a significantly higher proportion of children with a very low birth weight, a peripheral blood white blood cell count (WBC) of < 5×10⁹/L or > 20×10⁹/L, a C-reactive protein level of > 50 mg/L, a cerebrospinal fluid (CSF) WBC of > 500×10⁶/L, a CSF glucose level of < 1 mmol/L, or a CSF protein level of > 2 g/L, as well as significantly higher positive rates of blood culture and/or CSF culture, Gram-positive bacteria, and Streptococcus agalactiae (P < 0.05). The multivariate logistic regression analysis showed that a CSF glucose level of < 1 mmol/L and a CSF protein level of > 2 g/L were independent risk factors for poor prognosis of neonatal bacterial meningitis. Conclusions A CSF glucose level of < 1 mmol/L and a CSF protein level of > 2 g/L are risk factors for poor prognosis of neonatal bacterial meningitis.