儿童难治性细菌性脑膜炎临床分析

目的回顾性分析儿童难治性细菌性脑膜炎患儿的临床数据,以期提高儿童细菌性脑膜炎的诊治经验。方法回顾性分析31例儿童难治性细菌性脑膜炎及病程>1个月的住院患儿的临床资料。结果在抗生素治疗的基础上,大部分病例联合应用免疫治疗,发病后1 a成功随访23例,预后不良率高(69.57%);患儿住院期间血淋巴细胞亚群以CD19⁺、NK、CD20出现异常率较高(>50%),50%以上的患儿停用抗生素时不符合国内常见停药标准,应用免疫治疗对患儿预后的影响差异无统计学意义(P>0.05)。结论儿童难治性细菌性脑膜炎常出现外周血淋巴细胞亚群比例异常,临床应重视加强免疫方面的检查及治疗。临床决定患儿是否停用抗生素应多因素综合考虑及个体化治疗,为患儿制定最佳停用抗生素时间点。免疫调节治疗的长期效果仍待观察。

Clinical analysis of refractory bacterial meningitis in children

Objective To explore the the treatment and prognosis of 31 children with refractory bacterial meningitis.Methods Thirty-one children diagnosed with refractory bacterial meningitis and hospitalization longer than a month in the pediatrics department were analyzed retrospectively concerning the diagnosis,treatment,the clinical status at discharge and prognosis.Results Most cases received the immunotherapy and 23 patients were successfully followed up,69.57%of whom with poor prognosis.Concerning the results of blood tests in the 31 patients,the abnormal rate of CD19⁺,NK and CD20 was high in lymphocyte subsets(>50%),in the lymphocyte subsets analysis.Multivariate models showed that CD19⁺(B)abnormalities led to a lower prognosis scores(risk factors).More than 50%of all cases did not meet the domestic criteria in China when they stopped antibiotics treatment.There was no statistically significant difference in the effect of immunotherapy on the prognosis in our temporary study.Conclusion More attention should be paid to immunological examinations in children with refractory bacterial meningitis.The withdrawal of antibiotics should be based on multiple generalized factors.The optimal point for withdrawal of antibiotics should be considerated personalizedly.The long-term effect of immunotherapy still takes time to observe.