儿童化脓性脑膜炎临床观察及预后影响因素分析

摘要

Objective To analyze the changes of complete blood count(CBC),C-reactive protein (CRP),erythrocyte sedimentation rate(ESR),and calcitonin peptide(PCT)in children with purulent men-ingitis.Methods A total of 104 children with purulent meningitis were treated in Pediatric Department of Kaifeng Children's Hospital and Neihuang County People's Hospital of Henan Province from Jan.2015 to May 2016.The peripheral elbow blood was taken respectively on admission and 72 h after admission to de-termine the level of complete blood count,CRP,ESR and PCT.According to the prognosis,these children were divided into two groups:the good prognosis group(A,n= 34)and the bad prognosis group(B,n=70).Compare the routine blood test,the level and changes of the inflammatory marker indexes before and after treatment between the two groups.Results There were no deaths;34 children were cured,60 im-proved and 10 children were discharged on the patients'request.The onset mostly occurred in spring and fall,accounting for 61%;about 64% was induced by infection.The use of antibiotics before admission ac-counted for 81%,and 61% were abnormal on head examination.There was no statistical difference on RBC between the two groups respectively on admission or 72 h after admission(P >0.05).At 72 h after admis-sion,WBC,CRP and calcitonin were all lower than on admission,ESR in group A and PLT in group B were also lower,and the difference was of statistical significance(P <0.05).On admission and at 72 h after ad-mission,RBC,PLT and LYC of Group B were lower than group A,while WBC,CRP,ESR and calcitonin were high than group A,there being statistical difference(P <0.05).At 72 h after admission,the decrease degree of LYC in group A was lower than that in group B,while the decrease degree of CRP,ESR and cal-citonin was higher than that in group B,and there was statistical difference(P < 0.05).Conclusion The pathogenesis of purulent meningitis is complicated;inflammation level,routine blood test and ESR can be the prediction indexes of prognosis;dynamic determination of relevant indexes also can predict the curative effect.%目的：分析儿童化脓性脑膜炎全血细胞计数、C 反应蛋白（CRP）、血沉、降钙素原变化情况。方法2015年1月至2016年5月开封市儿童医院、河南省内黄县人民医院儿内科收治住院的化脓性脑膜炎患儿104例，患儿入院时、入院72 h 后，采集外周肘部静脉血，检测全血细胞计数、CRP、血沉、降钙素原水平，据患儿的预后，将患儿分为良好组（n＝34）、不良组（n＝70），对比两组患儿治疗前、治疗72 h 后血常规、炎症标志物指标水平、变化情况。结果治愈34例，好转60例，自动出院10例；春冬季发病占61％，感染诱发占64％，入院前使用过抗生素占81％，头颅检查异常占61％；两组入院时红细胞与入院后72 h比较差异无统计学意义（P ＞0.05）；入院72 h，两组白细胞、CRP、降钙素原均低于入院时，良好组血沉与不良组血小板低于入院时，差异有统计学意义（P ＜0.05）；入院时、入院后72 h，不良组红细胞、血小板、淋巴细胞低于良好组，白细胞、CRP、血沉、降钙素原高于良好组，差异有统计学意义（P ＜0.05）；良好组72 h 后，淋巴细胞下降率低于不良组，CRP、血沉、降钙素原下降率高于不良组，差异有统计学意义（P ＜0.05）。结论儿童化脓性脑膜炎发病机制较复杂，炎症水平、血常规表现、血沉等可作为患者预后预测指标，动态检测相关指标变化，也可预测疗效。