25例停药时脑脊液仍异常的社区获得性急性细菌性脑膜炎的临床和脑脊液随访

目的：总结停药时脑脊液仍异常的社区获得性急性细菌性脑膜炎（community acquired acute purulent meningitis， CA-APM）的临床和脑脊液特点，探讨治疗后无症状仅脑脊液异常的CA-APM是否可以停药及停药条件。方法：回顾性分析25例停药时脑脊液仍异常的CA-APM的临床和脑脊液随访资料，所有患儿随访6个月了解预后。结果：25例患儿均符合CA-APM诊断标准，抗菌药物治疗后体温已平稳（7～14 d），无神经系统阳性症状、体征，外周血白细胞及C-反应蛋白正常，血液和脑脊液培养阴性，头颅影像正常或脑萎缩或硬膜下积液2次检查无增多，无其他发现，但脑脊液仍异常，表现为白细胞（30～200）×106个/L，中性粒细胞1.8%～18.0%，糖1.51～4.12 mmol/L，蛋白 0.12～1.80 g/L；予以停药并随访6个月，生长发育正常，硬膜下积液吸收，其中17例分别在停药后（14～50 d）复查脑脊液逐渐恢复正常。结论：部分CA-APM治疗后无症状、体征，达到推荐疗程，且热退7 d以上，外周血炎症指标正常，血及脑脊液培养阴性，脑脊液蛋白水平下降及脑脊液葡萄糖＞1.51 mmol/L，头颅影像正常或脑萎缩或硬膜下积液2次检查无明显增多，无其他发现，可以尝试停药，减少抗菌药物应用。

Clinical and cerebrospinal fluid follow up of 25 cases of community acquired acute purulent meningitis with abnormal cerebrospinal fluid when stopping the medicine

Objective To summarize the clinical and cerebrospinal fluid characteristics of 25 cases of community acquired acute purulent meningitis with abnormal cerebrospinal fluid when stopping the medicine,to investigate whether CA-APM with abnormal cerebrospinal fluid after treatment can stop the drug.Method Retrospective analysis of the clinical and cerebrospinal fluid characteristics of 25 cases of community acquired acute purulent meningitis with abnormal cerebrospinal fluid when stopping the medicine. All cases were followed up (6-36) months to understand the prognosis.Result 25 cases were in line with the diagnostic criteria of CA-APM,the body temperature was stable (7-14) days after antibiotic therapy, no positive symptoms and signs of nervous system,peripheral white blood cells and C- reactive protein were normal,blood and cerebrospinal fluid culture negative,normal brain imaging or brain atrophy or no increase of subdural effusion with 2 times examination, no other findings;But the cerebrospinal fluid was still abnormal,white blood cell (30-200)×10₆/L,neutrophil (1.8-18)%, sugar (1.51-4.12) mmol/L, protein (0.12-1.8) g/L;To be stopped the drug and followed up (6-36) months, growth and development of normal, subdural effusion absorption, 17 cases of these were gradually returned to normal after (14-50) days after drug withdrawal.Conclusion Part of CA-APM without symptoms and signs after treatment,and achieved a recommended course of treatment,and no fever for more than 7 days, normal peripheral blood markers of inflammation, blood and cerebrospinal fluid culture negative, cerebrospinal fluid protein levels were decreased and CSF glucose > 1.51mmol/L, brain images of normal or brain atrophy or no increase of subdural effusion with 2 times examination, and no other findings,we can try stoppingthe drug, reduce the application of antibiotics.