儿童化脓性脑膜炎及结核性脑膜炎临床特点及预后不良危险因素的对比分析

目的:比较儿童化脓性脑膜炎(PM)及结核性脑膜炎(TBM)临床特点及预后不良危险因素。方法:收集PM患儿70例及TBM患儿44例的临床资料,比较2种疾病的临床特点,联合采用单因素及多因素Logistic回归分析法分析2种疾病预后不良的危险因素。结果:PM组患儿脑膜刺激征少于TBM组(P=0.004),但PM组患者脑脊液(CSF)氯化物平均值高于TBM组(P=0.020)。单因素分析发现年龄、意识障碍和CSF葡萄糖水平对PM患儿预后有显著影响(P=0.001,0.013,0.031);临床分期对TBM患儿预后有显著影响(P=0.039)。多因素Logistic回归分析发现患儿年龄(OR=1.811,95%CI 1.911-2.755,P=0.006)及意识障碍(OR=0.099,95%CI 0.017-0.584,P=0.011)是PM预后不良的危险因素;临床分期(OR=0.227,95%CI 0.081-0.633,P=0.005)是TBM患儿预后不良的危险因素。结论:脑膜刺激症和CSF氯化物可作为临床鉴别PM与TBM的参考指标;患儿年龄及意识障碍是PM预后不良的危险因素,临床分期是TBM患儿预后不良的危险因素。

Clinical Features and Risk Factors for Adverse Prognosis of Childhood Purulent Meningitis and Tuberculous Meningitis

Objective:To compare the clinical features and risk factors of adverse prognosis between childhood purulent meningitis (PM) and tuberculous meningitis (TBM).Methods:The clinical data of 70 cases PM and 44 cases TBM were collected.The clinicall features between the two groups were compared.The risk factors of adverge prognosis of two groups were analyzed by univariate analysis and multiariable logistic regression analysis.Results:High rate of meningeal irritation was clinical feature of PM (P=-0.004).Meanwhile,the level of cerebrospinal fluid (CSF)-chloride in PM group was higher than that in TBM patients (P=-0.020).Univariate analysis showed that the factors related to adverse prognosis of PM patients included age,disturbances of consciousness and CSF-glucose (P=0.001,0.013,0.031 respectively).The clinical staging was the only factor related to adverse prognosis of TBM (P=-0.039).Multiariable logistic regression analysis showed that age (OR=1.8tl,95％ CI 1.911-2.755,P=0.006) and disturbances of consciousness (OR=0.099,95％CI 0.017-0.584,P=-0.011) were associated with the adverse prognosis of PM.The clinical stage (OR=0.227,95％CI 0.081-0.633,P=-0.005) was associated with the adverse prognosis of PM.Conclusion:Meningeal irritation and the level of CSF-chloride could be the important indexes for the differential diagnosis between the two diseases.For children with PM,age and disturbances of consciousness were independent risk factors for adverse prognosis.Meanwhile,the clinical stage was the only independent risk factor for adverse prognosis of TBM.