学龄儿童流感嗜血杆菌脑膜炎的后遗症

The sequelae of Haemophilus influenzae meningitis in school-age children.

作者信息

Taylor H G, Mills E L, Ciampi A, du Berger R, Watters G V, Gold R, MacDonald N, Michaels R H

机构信息

Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland OH.

出版信息

N Engl J Med. 1990 Dec 13;323(24):1657-63. doi: 10.1056/NEJM199012133232403.

DOI:10.1056/NEJM199012133232403

PMID:2233963

Abstract

BACKGROUND

Previous data on the consequences of Haemophilus influenzae type b meningitis for school-age children have been inconsistent, and much of the information on risk factors has been inconclusive. The present study was designed to evaluate the sequelae of this disease with a protocol for the comprehensive assessment of neuropsychological function.

METHODS

Ninety-seven school-age children (mean age, 9.6 years), each of whom had a school-age sibling, were recruited from a survey of the medical records of 519 children treated for H. influenzae type b meningitis between 1972 and 1984 (at a mean age of 17 months) at the children's hospitals of Toronto, Ottawa, and Montreal. Of the 97 children, 41 had had an acute neurologic complication. Sequelae were assessed by comparing the index children with their nearest siblings on the basis of standardized measures of cognitive, academic, and behavioral status.

RESULTS

Only 14 children (14 percent) had persisting neurologic sequelae: sensorineural hearing loss in 11 (unilateral in 6 and bilateral in 5), seizure disorder in 2, and hemiplegia and mental retardation in 1. Although the total sample of index children scored slightly below the siblings in reading ability, the 56 children without acute-phase neurologic complications (58 percent) were indistinguishable from their siblings on all measures. The differences between the groups were small even for the 41 pairs in which the index child had had an acute neurologic complication (mean full-scale IQ, 102 for the index children vs. 109 for the siblings). Sequelae were also associated with lower socioeconomic status and a lower ratio of glucose in cerebrospinal fluid to that in blood at the time of the meningitis. Behavioral problems were more prominent in index boys than index girls and in those who were older at the time of testing, but sex and age were not related to cognitive or academic sequelae.

CONCLUSIONS

We find a favorable prognosis for the majority of children who are treated for meningitis caused by H. influenzae type b.

摘要

背景

先前关于b型流感嗜血杆菌脑膜炎对学龄儿童影响的数据并不一致，而且许多关于危险因素的信息也尚无定论。本研究旨在通过一项综合评估神经心理功能的方案来评估该疾病的后遗症。

方法

从对1972年至1984年间在多伦多、渥太华和蒙特利尔儿童医院接受b型流感嗜血杆菌脑膜炎治疗的519名儿童（平均年龄17个月）的病历调查中招募了97名学龄儿童（平均年龄9.6岁），他们每人都有一个学龄兄弟姐妹。在这97名儿童中，41名曾有急性神经系统并发症。通过基于认知、学业和行为状况的标准化测量，将受试儿童与其最亲近的兄弟姐妹进行比较来评估后遗症。

结果

只有14名儿童（14%）有持续的神经系统后遗症：11名有感觉神经性听力丧失（6名单侧，5名双侧），2名有癫痫障碍，1名有偏瘫和智力发育迟缓。尽管受试儿童的总样本在阅读能力上略低于其兄弟姐妹，但56名没有急性期神经系统并发症的儿童（58%）在所有测量指标上与他们的兄弟姐妹没有差异。即使对于41对受试儿童有急性神经系统并发症的情况，两组之间的差异也很小（受试儿童的平均全量表智商为102，兄弟姐妹为109）。后遗症还与较低的社会经济地位以及脑膜炎时脑脊液中葡萄糖与血液中葡萄糖的较低比例有关。行为问题在受试男孩中比受试女孩更突出，在测试时年龄较大的儿童中更突出，但性别和年龄与认知或学业后遗症无关。