儿童细菌性脑膜炎预警指标的病例对照研究

摘要

目的：探讨儿童细菌性脑膜炎的预警因素，为其诊治与防控提供依据。方法选取2007—2013年石家庄市急性脑膜炎脑炎监测项目EpiData数据库，采用1：2配对病例对照研究探讨儿童细菌性脑膜炎预警信息。研究组为实验室确诊细菌性脑膜炎病例，对照组为实验室确诊非细菌性病原体脑膜炎病例。收集两组人口统计学信息、流行病学特征、临床表现、实验室常规检测结果。并采用多因素条件Logistic回归分析影响儿童细菌性脑膜炎的因素。结果单因素条件Logistic回归分析结果显示，研究组和对照组年龄、发病季节、呕吐、颈项强直、血标本中性粒细胞分数、脑脊液外观、脑脊液白细胞计数比较，差异均有统计学意义（ P<0.05）。以是否发生细菌性脑膜炎为因变量，以单因素分析有统计学意义的指标为自变量，多因素条件Logistic回归分析结果显示，年龄（ OR=10.36，P=0.003）、发病季节（OR=0.06，P=0.007）、颈项强直（OR=17.01，P=0.048）、血标本中性粒细胞分数（OR=12.43，P=0.028）、脑脊液外观（OR=2.59，P=0.014）和脑脊液白细胞计数（OR=2.31，P=0.047）进入回归方程。结论患儿1~<5岁、非夏季发病、颈项强直、血标本中性粒细胞分数增高、脑脊液外观混浊及脑脊液白细胞计数增高是儿童细菌性脑膜炎早期预警指标，可用于病例预警和人群防控。%Objective To explore predictors of bacterial meningitis in children in order to provide references for diagnosis,treatment and prevention. Methods We selected information from EpiData,a data base of Shijiazhuang monitoring project of acute meningitis and encephalitis. The time range of selected data was from 2007 to 2013. A 1:2 case-control study was conducted to investigate the predictors for bacterial meningitis in children. The case group comprised patients confirmed with bacterial meningitis, and the control group comprised patients confirmed with non - bacterial meningitis. Statistic data, epidemiological characteristics, clinical manifestations and conventional laboratory indicators of the two groups were collected. multivariate conditional Logistic regression analysis was undertaken to investigate the influencing factors for bacterial meningitis in children. Results The single factor conditional Logistic regression analysis showed that the two groups were significantly different(P <0. 05)in age,onset season,vomit,neck rigidity,neutrophile granulocyte in blood specimen, appearance of cerebrospinal fluid and white blood cell count in cerebrospinal fluid. With the occurrence of bacterial meningitis or not as dependent variables and the indexes that have statistical significance in univariate analysis as independent variables, multivariate conditional Logistic regression analysis showed that age(OR=10. 36,P=0. 003),onset season(OR=0. 06,P=0. 007),neck rigidity(OR=17. 01,P=0. 048),neutrophile granulocyte in blood specimen(OR=12. 43,P=0. 028), appearance of cerebrospinal fluid(OR=2. 59,P=0. 014)and white blood cell count in cerebrospinal fluid(OR=2. 31,P=0. 047) entered the regression equation. Conclusion Being aged 1 to < 5, no summer onset, neck rigidity, score of neutrophile granulocyte in blood specimen,appearance of cerebrospinal fluid and white blood cell count in cerebrospinal fluid are predictors for bacterial meningitis in children,which could be used for the precaution and prevention of the disease in children.