Barsić B, Lisić M, Himbele J, Beus I, Marton E, Balentić V, Palić J
University Hospital for Infectious Diseases, Dr Fran Mihaljević, Zagreb, Croatia.
Neurol Croat. 1992;41(3):131-9.
The authors reviewed 70 cases of Streptococcus pneumoniae meningitis occurring over a 5-years period (1985-1989). Clinical features, outcome and laboratory findings in elderly patients (> 60 years of age, 21 patients) were compared with those in younger patients (< 59 years of age, 49 patients). Mortality rate was 57% in elderly group vs. 20% in younger. Admission to the hospital was delayed in the elderly. Only 67.6% of them were admitted on the first two days of the illness vs. 81.6% of younger patients. Nearly 62% of them were deeply soporous or comatose on admission (Mathew-Lawson grade 3 and 4), while in the control group only 31% of patients had such severely altered mental status. Although glucose cerebrospinal fluid (CSF)/blood ratio tended to be lower in the elderly (0.09 vs 0.17) the difference did not reach statistical significance. Thrombocytes in the peripheral blood were lower in the elderly (113 x 10(9)/L vs. 148 x 10(9)/L, p < 0.05). When we compared laboratory findings in survivors and nonsurvivors from both groups, nonsurvivors had significantly lower glucose CSF/blood ratio (0.054 vs. 0.174, p = 0.008), and higher bilirubin levels in serum (27.9 vs 14.7, p = 0.003), but differences were more obvious in younger group of patients. Our results suggest that there is increased risk of death among elderly patients. It can be at least partially attributed to their later admittance to the hospital and because of that delayed start of the appropriate therapy and more severe conscious disturbances. All these factors contribute to the greater case-fatality ratio observed in elderly patients with pneumococcal meningitis.
作者回顾了5年期间（1985 - 1989年）发生的70例肺炎链球菌脑膜炎病例。将老年患者（>60岁，21例）的临床特征、转归及实验室检查结果与年轻患者（<59岁，49例）进行了比较。老年组死亡率为57%，而年轻组为20%。老年患者入院延迟。他们中只有67.6%在发病的前两天入院，而年轻患者为81.6%。近62%的老年患者入院时深度嗜睡或昏迷（马修 - 劳森分级3级和4级），而对照组只有31%的患者有如此严重的精神状态改变。虽然老年患者脑脊液（CSF）/血液葡萄糖比值往往较低（0.09对0.17），但差异未达到统计学意义。老年患者外周血血小板较低（113×10⁹/L对148×10⁹/L，p<0.05）。当我们比较两组存活者和非存活者的实验室检查结果时，非存活者的脑脊液/血液葡萄糖比值显著较低（0.054对0.174，p = 0.008），血清胆红素水平较高（27.9对14.7，p = 0.003），但差异在年轻患者组中更明显。我们的结果表明，老年患者死亡风险增加。这至少部分归因于他们入院较晚，因此适当治疗开始延迟以及意识障碍更严重。所有这些因素导致肺炎球菌脑膜炎老年患者的病死率更高。
