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
2015年
18期
1420-1424
,共5页
目的：探讨不同年龄阶段细菌性脑膜炎患儿临床特征的变化和影像学改变,为临床诊断提供依据。方法以广州市妇女儿童医疗中心2011年1月至2013年6月收治的89例细菌性脑膜炎患儿为研究对象,其中男58例,女31例。足月新生儿组34例、婴儿组41例、1岁以上年龄组14例。比较3组间的临床特征、辅助检查结果和影像学异常特点及差异。结果1.非特异性表现：54例有高热,44例有呼吸道症状,12例有消化道症状。1岁以上年龄组高热的发生率显著高于新生儿组和婴儿组(χ2=10.093,P<0.05)。2.神经系统主要表现：惊厥44例(49.4%),反应差36例(40.4%),呕吐21例(23.6%),颈抵抗9例(10.1%),前囟饱满7例(7.9%),头痛6例(6.7%),肢体瘫痪5例(5.6%)。婴儿组惊厥的发生率显著高于足月新生儿组和1岁以上年龄组,差异有统计学意义(χ2=6.571,P<0.05)；1岁以上年龄组呕吐、头痛、颈抵抗的发生率显著高于足月新生儿组和婴儿组(χ2=12.063、34.466、7.177,P均<0.05)。3.检验结果：外周血白细胞(WBC)[2.20~60.60(16.49±10.37)]×109/L,外周血超敏C反应蛋白[4.00~376.53(131.07±86.91)]g/L。脑脊液WBC[1~21800(910.05±274.07)]×106/L；脑脊液糖水平0.00~4.50(1.72±1.03)mmol/L；脑脊液微量蛋白水平0.42~4.89(1.64±1.03)g/L。上述指标各组间比较差异均无统计学意义(P均>0.05)。40例脑脊液改变不典型的患儿中,脑脊液葡萄糖/血清葡萄糖比值≤0.4的23例和血细菌培养阳性的15例。4.影像学结果：头颅MRI检查75例,51例异常。头颅CT检查30例,15例异常。婴儿组头颅CT/MRI总异常率、头颅MRI的异常率和头颅MRI呈现脑膜炎改变的比例均较新生儿组、1岁以上年龄组高,差异均有统计学意义(χ2=11．768、9.047、7.674,P均<0.05)。头颅MRI显示脑膜炎、硬膜下积液的异常率显著高于头颅CT,差异有统计学意义(χ2=7.430、5.291,P均<0.05)。结论新生儿和婴儿细菌性脑膜炎临床表现不典型,宜早实施腰椎穿刺检查。脑脊液改变不典型时,脑脊液/血清糖比值≤0.4、头颅MRI序列检查和血细菌培养三者之间,两两联合对识别细菌感染较为重要。头颅MRI序列识别患儿脑膜病变明显优于CT。
目的：探討不同年齡階段細菌性腦膜炎患兒臨床特徵的變化和影像學改變,為臨床診斷提供依據。方法以廣州市婦女兒童醫療中心2011年1月至2013年6月收治的89例細菌性腦膜炎患兒為研究對象,其中男58例,女31例。足月新生兒組34例、嬰兒組41例、1歲以上年齡組14例。比較3組間的臨床特徵、輔助檢查結果和影像學異常特點及差異。結果1.非特異性錶現：54例有高熱,44例有呼吸道癥狀,12例有消化道癥狀。1歲以上年齡組高熱的髮生率顯著高于新生兒組和嬰兒組(χ2=10.093,P<0.05)。2.神經繫統主要錶現：驚厥44例(49.4%),反應差36例(40.4%),嘔吐21例(23.6%),頸牴抗9例(10.1%),前囟飽滿7例(7.9%),頭痛6例(6.7%),肢體癱瘓5例(5.6%)。嬰兒組驚厥的髮生率顯著高于足月新生兒組和1歲以上年齡組,差異有統計學意義(χ2=6.571,P<0.05)；1歲以上年齡組嘔吐、頭痛、頸牴抗的髮生率顯著高于足月新生兒組和嬰兒組(χ2=12.063、34.466、7.177,P均<0.05)。3.檢驗結果：外週血白細胞(WBC)[2.20~60.60(16.49±10.37)]×109/L,外週血超敏C反應蛋白[4.00~376.53(131.07±86.91)]g/L。腦脊液WBC[1~21800(910.05±274.07)]×106/L；腦脊液糖水平0.00~4.50(1.72±1.03)mmol/L；腦脊液微量蛋白水平0.42~4.89(1.64±1.03)g/L。上述指標各組間比較差異均無統計學意義(P均>0.05)。40例腦脊液改變不典型的患兒中,腦脊液葡萄糖/血清葡萄糖比值≤0.4的23例和血細菌培養暘性的15例。4.影像學結果：頭顱MRI檢查75例,51例異常。頭顱CT檢查30例,15例異常。嬰兒組頭顱CT/MRI總異常率、頭顱MRI的異常率和頭顱MRI呈現腦膜炎改變的比例均較新生兒組、1歲以上年齡組高,差異均有統計學意義(χ2=11．768、9.047、7.674,P均<0.05)。頭顱MRI顯示腦膜炎、硬膜下積液的異常率顯著高于頭顱CT,差異有統計學意義(χ2=7.430、5.291,P均<0.05)。結論新生兒和嬰兒細菌性腦膜炎臨床錶現不典型,宜早實施腰椎穿刺檢查。腦脊液改變不典型時,腦脊液/血清糖比值≤0.4、頭顱MRI序列檢查和血細菌培養三者之間,兩兩聯閤對識彆細菌感染較為重要。頭顱MRI序列識彆患兒腦膜病變明顯優于CT。
목적：탐토불동년령계단세균성뇌막염환인림상특정적변화화영상학개변,위림상진단제공의거。방법이엄주시부녀인동의료중심2011년1월지2013년6월수치적89례세균성뇌막염환인위연구대상,기중남58례,녀31례。족월신생인조34례、영인조41례、1세이상년령조14례。비교3조간적림상특정、보조검사결과화영상학이상특점급차이。결과1.비특이성표현：54례유고열,44례유호흡도증상,12례유소화도증상。1세이상년령조고열적발생솔현저고우신생인조화영인조(χ2=10.093,P<0.05)。2.신경계통주요표현：량궐44례(49.4%),반응차36례(40.4%),구토21례(23.6%),경저항9례(10.1%),전신포만7례(7.9%),두통6례(6.7%),지체탄탄5례(5.6%)。영인조량궐적발생솔현저고우족월신생인조화1세이상년령조,차이유통계학의의(χ2=6.571,P<0.05)；1세이상년령조구토、두통、경저항적발생솔현저고우족월신생인조화영인조(χ2=12.063、34.466、7.177,P균<0.05)。3.검험결과：외주혈백세포(WBC)[2.20~60.60(16.49±10.37)]×109/L,외주혈초민C반응단백[4.00~376.53(131.07±86.91)]g/L。뇌척액WBC[1~21800(910.05±274.07)]×106/L；뇌척액당수평0.00~4.50(1.72±1.03)mmol/L；뇌척액미량단백수평0.42~4.89(1.64±1.03)g/L。상술지표각조간비교차이균무통계학의의(P균>0.05)。40례뇌척액개변불전형적환인중,뇌척액포도당/혈청포도당비치≤0.4적23례화혈세균배양양성적15례。4.영상학결과：두로MRI검사75례,51례이상。두로CT검사30례,15례이상。영인조두로CT/MRI총이상솔、두로MRI적이상솔화두로MRI정현뇌막염개변적비례균교신생인조、1세이상년령조고,차이균유통계학의의(χ2=11．768、9.047、7.674,P균<0.05)。두로MRI현시뇌막염、경막하적액적이상솔현저고우두로CT,차이유통계학의의(χ2=7.430、5.291,P균<0.05)。결론신생인화영인세균성뇌막염림상표현불전형,의조실시요추천자검사。뇌척액개변불전형시,뇌척액/혈청당비치≤0.4、두로MRI서렬검사화혈세균배양삼자지간,량량연합대식별세균감염교위중요。두로MRI서렬식별환인뇌막병변명현우우CT。
Objective To investigate the clinical features and the imaging examination changes of bacterial meningitis in children of different age groups,and to offer theoretical basis for the clinic diagnosis of bacterial meningi-tis. Methods The sick children with bacterial meningitis treated in Guangzhou Women and Children′s Medical Center from January 2011 to June 2013,were recruited and divided into three groups according to the age,including newborns group,infants group and more than 1 year group. Eighty-nine cases with purulent meningitis were recruited,included 58 males and 31 females. Among them,there were 34 cases in the newborns group,41 cases in the infants group and 14 ca-ses in the more than 1-year group. The information on the clinical features,laboratory examination and the imaging ex-amination were summarized and analyzed,and were compared among the 3 groups. Results (1)Among them,54 cases with high fever,44 cases with respiratory symptoms,12 cases with alimentary tract symptoms. (2)The major neurologi-cal features included convulsions(44 cases,49. 4%),fatigue(36 cases,40. 4%),vomiting(21 cases,23. 6%),cervical rigidity(9 cases,10. 1%),fontanel full(7 cases,7. 9%),headache(6 cases,6. 7%),limb paralysis(5 cases,5. 6%). The percentage of high fever,vomiting,headache,cervical rigidity in the more than 1 year group were significantly more than those of the newborns group and the infants group(χ2=10. 093,12. 063,34. 466,7. 177,all P<0. 05). (3)Among them,whitebloodcell(WBC)accountswerefrom2.20to60.60×109/L,themeanwas(16.49±10.37)×109/L.Hy-persensitive C-reaction protein concentration in blood was 4. 00 to 376. 53 g/L,the mean was (131. 07±86. 91) g/L. In cerebrospinal fluid(CSF),WBC accounts were from 1 to 21 800×106/L,the mean was (910. 05±274. 07)×106/L, the glucose concentration from 0. 00 to 4. 50 mmol/L,the mean (1. 72±1. 03)mmol/L,the protein concentration from 0. 42 to 4. 89 g/L,the mean was(1. 64±1. 03)g/L. In 40 cases with atypical CSF change, 23 cases with CSF glucose ratio(CSF glucose/blood glucose) less than or equal to 0. 4, and 15 cases with blood cultures positive. (4)The image examination showed magnetic resonance imaging( MRI) abnormalities in 51/75 cases,computerized tomography( CT) scan abnormalities in 15/30 cases. The percentage of convulsions,the brain MRI abnormalities and the MRI display rate of bacterial meningitis in the infants group were significantly more than those of the newborns group and the more than 1 year group(χ2=11. 768,9. 047,7. 674,all P<0. 05). The display rate of meningitis and subdural hydroma by the brain MRI were significantly more than those of the head CT scan(χ2=7. 430,5. 291,all P<0. 05). Conclusions Be-cause of the atypical clinical features of bacterial meningitis in newborn and infant, lumber puncture should be per-formed in all doubtful cases who had a fever and/or seizure. CSF glucose less than or equal to 0. 4 of simultaneously ob-tained blood glucose value,the enhanced MRI sequence or blood cultures were useful for the likelihood of meningitis,if CSF chemistries and cytology vary atypically. The MRI sequence can significantly mostly improve the display rate of bacterial meningitis than the enhance CT.
