Department of Neurology, Children's Hospital of Chongqing Medical University, China; Ministry of Education Key Laboratory of Child Development and Disorders, China; Key Laboratory of Pediatrics in Chongqing, China; Chongqing International Science and Technology Cooperation Center for Child Development and Disorders, China.
J Infect Public Health. 2018 Mar-Apr;11(2):238-242. doi: 10.1016/j.jiph.2017.07.007. Epub 2017 Aug 7.
This study was undertaken to investigate the relationship between cerebrospinal fluid abnormalities and prognosis in pediatric refractory purulent meningitis. Ninety cases of pediatric refractory purulent meningitis were stratified into "good" (n=33) or "poor" (n=57) prognosis groups according to the Glasgow clinical outcome scores. The symptoms, laboratory results, and prognosis were compared by using univariate and multivariate logistic regression analyses. Univariate analysis showed that poor prognosis was associated with: unequal pupil size in both eyes; positive Babinski sign; CSF-WBC >500×10/L, CSF protein concentration >1.0g/L, CSF glucose content <1.5mmol/L; initial procalcitonin result >0.1ng/dL on admission; hemoglobin <90g/L during hospitalization; abnormal head imaging, and abnormal electroencephalogram. On multivariate analysis only unequal pupil size in both eyes and CSF glucose content <1.5mmol/L remained significant. The CSF protein concentration was significantly different between groups at discharge. The cutoff value was 0.68g/L. We recommend that discharged patients meet the following criteria: full antibiotic course and over 1 week of defervesce, disappearance of acute phase symptoms, CSF-WBC ≤28×10/L, CSF glucose >1.75mmol/L, and protein <0.68g/L. The patient may be discharged for follow-up if no relapse occurs during 3-5 days of observation after drug withdrawal.
本研究旨在探讨脑脊液异常与小儿难治性化脓性脑膜炎预后的关系。根据格拉斯哥临床结局评分，将 90 例小儿难治性化脓性脑膜炎分为“预后良好”（n=33）或“预后不良”（n=57）组。采用单因素和多因素 logistic 回归分析比较症状、实验室结果和预后。单因素分析显示，预后不良与以下因素有关：双眼瞳孔不等大；巴氏征阳性；CSF-WBC>500×10/L、CSF 蛋白浓度>1.0g/L、CSF 葡萄糖含量<1.5mmol/L；入院时初始降钙素原结果>0.1ng/dL；住院期间血红蛋白<90g/L；头颅影像学异常和脑电图异常。多因素分析仅双眼瞳孔不等大和 CSF 葡萄糖含量<1.5mmol/L 有统计学意义。出院时脑脊液蛋白浓度在两组间有显著差异，截断值为 0.68g/L。我们建议出院标准为：抗生素疗程完整且退热>1 周，急性期症状消失，CSF-WBC≤28×10/L，CSF 葡萄糖>1.75mmol/L，蛋白<0.68g/L。停药后观察 3-5 天无复发，可出院随访。
