中华实用儿科临床杂志
中華實用兒科臨床雜誌
중화실용인과림상잡지
Journal of Applied Clinical Pediatrics
2014年
10期
742-746
,共5页
脑膜炎%细菌%流行病学%儿童
腦膜炎%細菌%流行病學%兒童
뇌막염%세균%류행병학%인동
Meningitis%Bacterium%Epidemiology%Child
目的 分析近20年儿章细菌性脑膜炎在性别、年龄、地域、季节及致病菌的分布情况及变化趋势,为临床诊治提供参考.方法 回顾性统计重庆医科大学附属儿童医院1993年1月至2013年1月确诊的1 855例17岁以下儿章细菌性脑膜炎的临床资料,分析其性别、年龄、地域、季节和检出 196例致病菌分布情况;并将1993年1月至2002年12月的666例设为A组,2003年1月至2013年1月的1 189例设为B组;再按年龄分为新生儿、＞1个月～1岁、＞1 ～3岁、＞3 ～10岁和＞10 ～ 17岁的5个年龄段组,比较2组临床资料及各年龄段致病菌的变化情况.结果 1 855例儿童细菌性脑膜炎中,男∶女=1.82∶1.00,农村∶城市=1.40∶1.00;春、夏季1 054例(56.82％);年龄≤1岁有1 123例(60.54％),而年龄＞10岁的患儿仅占8.25％ (135例).A、B组患儿在女童[215例(32.28％)比443例(37.26％)]、城市[256例(38.44％)比517例(43.48％)]、秋季[102例(15.32％)比265例(22.29％)]和＞1个月～1岁[272例(40.84％)比606例(50.97％)]等方面分布差异有统计学意义(x2=4.62、4.47、25.51、25.52,P均＜0.05).196株病原菌中凝固酶阴性葡萄球菌(43株,21.94％)、肺炎链球菌(32株,16.33％)、腑膜炎奈瑟球菌(17株,8.67％)和大肠埃希菌(15株,7.65％)为主要致病菌.凝固酶阴性葡萄球菌和大肠埃希菌均在1岁以内的所占致病菌比率较高(x2=4.57、14.37,P均＜0.05),肺炎链球菌在1岁以上(x2=14.93,P＜0.05)、脑膜炎奈瑟球菌在3岁以上(x2=19.76,P＜0.05)所占致病菌比率较高.A、B2组病原菌比较中,除肺炎链球菌在B组致病菌占有率较高之外(x2=11.78,P＜0.05),其余各年龄段常见致病菌均无明显增减趋势.结论 近年来儿童细菌性脑膜炎在性别、地域、发病季节和发病年龄分布方面均有变化,且男童、农村、春夏季节和婴幼儿是其主要因素.儿童细菌性脑膜炎以凝固酶阴性葡萄球菌、肺炎链球菌、大肠埃希菌等条件致病菌为主要菌群,且近10年肺炎链球菌脑膜炎有增长.
目的 分析近20年兒章細菌性腦膜炎在性彆、年齡、地域、季節及緻病菌的分佈情況及變化趨勢,為臨床診治提供參攷.方法 迴顧性統計重慶醫科大學附屬兒童醫院1993年1月至2013年1月確診的1 855例17歲以下兒章細菌性腦膜炎的臨床資料,分析其性彆、年齡、地域、季節和檢齣 196例緻病菌分佈情況;併將1993年1月至2002年12月的666例設為A組,2003年1月至2013年1月的1 189例設為B組;再按年齡分為新生兒、＞1箇月～1歲、＞1 ～3歲、＞3 ～10歲和＞10 ～ 17歲的5箇年齡段組,比較2組臨床資料及各年齡段緻病菌的變化情況.結果 1 855例兒童細菌性腦膜炎中,男∶女=1.82∶1.00,農村∶城市=1.40∶1.00;春、夏季1 054例(56.82％);年齡≤1歲有1 123例(60.54％),而年齡＞10歲的患兒僅佔8.25％ (135例).A、B組患兒在女童[215例(32.28％)比443例(37.26％)]、城市[256例(38.44％)比517例(43.48％)]、鞦季[102例(15.32％)比265例(22.29％)]和＞1箇月～1歲[272例(40.84％)比606例(50.97％)]等方麵分佈差異有統計學意義(x2=4.62、4.47、25.51、25.52,P均＜0.05).196株病原菌中凝固酶陰性葡萄毬菌(43株,21.94％)、肺炎鏈毬菌(32株,16.33％)、腑膜炎奈瑟毬菌(17株,8.67％)和大腸埃希菌(15株,7.65％)為主要緻病菌.凝固酶陰性葡萄毬菌和大腸埃希菌均在1歲以內的所佔緻病菌比率較高(x2=4.57、14.37,P均＜0.05),肺炎鏈毬菌在1歲以上(x2=14.93,P＜0.05)、腦膜炎奈瑟毬菌在3歲以上(x2=19.76,P＜0.05)所佔緻病菌比率較高.A、B2組病原菌比較中,除肺炎鏈毬菌在B組緻病菌佔有率較高之外(x2=11.78,P＜0.05),其餘各年齡段常見緻病菌均無明顯增減趨勢.結論 近年來兒童細菌性腦膜炎在性彆、地域、髮病季節和髮病年齡分佈方麵均有變化,且男童、農村、春夏季節和嬰幼兒是其主要因素.兒童細菌性腦膜炎以凝固酶陰性葡萄毬菌、肺炎鏈毬菌、大腸埃希菌等條件緻病菌為主要菌群,且近10年肺炎鏈毬菌腦膜炎有增長.
목적 분석근20년인장세균성뇌막염재성별、년령、지역、계절급치병균적분포정황급변화추세,위림상진치제공삼고.방법 회고성통계중경의과대학부속인동의원1993년1월지2013년1월학진적1 855례17세이하인장세균성뇌막염적림상자료,분석기성별、년령、지역、계절화검출 196례치병균분포정황;병장1993년1월지2002년12월적666례설위A조,2003년1월지2013년1월적1 189례설위B조;재안년령분위신생인、＞1개월～1세、＞1 ～3세、＞3 ～10세화＞10 ～ 17세적5개년령단조,비교2조림상자료급각년령단치병균적변화정황.결과 1 855례인동세균성뇌막염중,남∶녀=1.82∶1.00,농촌∶성시=1.40∶1.00;춘、하계1 054례(56.82％);년령≤1세유1 123례(60.54％),이년령＞10세적환인부점8.25％ (135례).A、B조환인재녀동[215례(32.28％)비443례(37.26％)]、성시[256례(38.44％)비517례(43.48％)]、추계[102례(15.32％)비265례(22.29％)]화＞1개월～1세[272례(40.84％)비606례(50.97％)]등방면분포차이유통계학의의(x2=4.62、4.47、25.51、25.52,P균＜0.05).196주병원균중응고매음성포도구균(43주,21.94％)、폐염련구균(32주,16.33％)、부막염내슬구균(17주,8.67％)화대장애희균(15주,7.65％)위주요치병균.응고매음성포도구균화대장애희균균재1세이내적소점치병균비솔교고(x2=4.57、14.37,P균＜0.05),폐염련구균재1세이상(x2=14.93,P＜0.05)、뇌막염내슬구균재3세이상(x2=19.76,P＜0.05)소점치병균비솔교고.A、B2조병원균비교중,제폐염련구균재B조치병균점유솔교고지외(x2=11.78,P＜0.05),기여각년령단상견치병균균무명현증감추세.결론 근년래인동세균성뇌막염재성별、지역、발병계절화발병년령분포방면균유변화,차남동、농촌、춘하계절화영유인시기주요인소.인동세균성뇌막염이응고매음성포도구균、폐염련구균、대장애희균등조건치병균위주요균군,차근10년폐염련구균뇌막염유증장.
Objective To study the distribution and changes of the purulent meningitis in gender,age,region,season and pathogens in children during the past 20 years.Methods All the basic clirical features of purulent meningitis patients less than 17 years old in Children's Hospital of Chongqing Medical University from Jan.1993 to Jan.2013 were analyzed retrospectively.A total of 1 855 patients were divided into 2 groups according to their date of admission.Group A included 666 patients admitted from Jan.1993 to Dec.2002,and group B included 1 189 cases admitted from Jan.2003 to Jan.2013.Then,they were divided into 5 groups according to their ages,including neonate group,＞ 1 month-1 year old aoup,＞ 1-3 years old group,＞ 3-10 years old group,＞ 10-17 years old group.Results Of the 1 855 cases,there were 1 054 cases (56.82％) admitted in the spring and summer,and 1 123 cases (60.54％) were younger than 1 year of age.The ratio of male to female cases was 1.82 to 1.00 and that of country patients to urban patients was 1.40 to 1.00.The distributions were female patients (443 cases,37.26％),urban patients (517 cases,43.48％),and the ratio of patients admitted in the autumn (265 cases,22.29％) and patients younger than 1 year of age (606 cases,50.97％) in group B,which were significantly higher than those [215 cases (32.28％),256 cases (38.44％),102 cases (15.32％),272 cases (40.84％)] of group A (x2 =4.62,4.47,25.51,25.52,all P ＜ 0.05).The predominant isolated bacteria from cerebrospinal fluid were coagulase negative staphylococcus (43/196 cases,21.94％),Streptococcus pneumoniae (32/196 cases,16.33％),Neisseria meningitidis (17/196 cases,8.67％) and Escherichia coli (15/196 cases,7.65％).Coagulase negative staphylococcus and Escherichia coli both accounted for higher rates of pathogenic bacteria in 1 year old than that of pathogenic bacteria more than 1 year old (x2 =4.57,14.37,all P ＜ 0.05),while Streptococcus pneumoniae and Neisseria meningitidis both had higher rates of pathogenic bacteria more than 1 year old and more than 3 years old,respectively (x2 =14.93,19.76,all P ＜ 0.05).Onfly cases in group B with Streptococcus pneumoniae were higher than those in group A (x2 =11.78,P ＜ 0.05),while the other common bacteria in each age group were of no difference between group A and group B.Conclusions There had been some changes in the epidemiological distribution of purulent meningitis during the past 20 years.The main risk factors were male in gender,patients in rural areas,onset in the spring or summer and infants in early age.The predominant isolated bacteria from cerebrospinal fluid were some opportunistic pathogens,including coagulase negative staphylococcus,Streptococcus pneumoniae,and Escherichia coli.Streptococcus pneumoniae meningitis was increased during the past 10 years.
