Takayanagi M, Yamamoto K, Nakagawa H, Iinuma K
Department of Pediatrics, Tohoku University School of Medicine, Sendai.
No To Hattatsu. 1997 Jul;29(4):291-7.
Treatment of bacterial meningitis depends on its severity. The signs, symptoms, and laboratory values of 51 patients with bacterial meningitis admitting to the Department of Pediatrics at Sendai City Hospital from January 1985 to December 1994 were analyzed in order to evaluate their prognostic value. The overall mortality rate was 3.9%. The incidence of neurological deficit on discharge was 31.4%. According to their prognoses, patients were divided into two groups: those who recovered with no detectable disabilities (good prognosis) and those who died or were left with neurological deficits (poor prognosis). An analysis of these groups using Fisher's exact probability test revealed that the following risk factors were associated with poor prognosis: 1) duration of fever (including the periods of relapse) for more than 10 days ; 2) abnormal findings on brain imaging, such as cerebral infarction, cerebral hemorrhage, cerebral abscess and subdural effusion: 3 initial serum CRP value above 16 mg/dl; 4) initial CSF glucose value below 12 mg/dl; and 5) initial CSF LDH value above 220 IU/l. Streptococcus pneumoniae infection carried the worst prognosis: the causal organism of both the two fetal cases was S. pneumoniae. The incidence of poor prognosis was also high in S. pneumoniae meningitis (60.0%), compared to those by Hemophilus influenzae (46.7%) and group B streptococcus (25.0%). In the cases in which causal agents were not detected, this incidence was as low as 10 percent, showing significant difference from cases in which causal agents were identified. In order to improve the prognosis of bacterial meningitis, factors associated with poor prognosis should be recognized at early stages of the illness.
细菌性脑膜炎的治疗取决于其严重程度。为了评估51例1985年1月至1994年12月入住仙台市立医院儿科的细菌性脑膜炎患者的体征、症状和实验室检查值的预后价值，对其进行了分析。总体死亡率为3.9%。出院时神经功能缺损的发生率为31.4%。根据预后情况，将患者分为两组：康复后无明显残疾者（预后良好）和死亡或留有神经功能缺损者（预后不良）。使用Fisher精确概率检验对这些组进行分析后发现，以下危险因素与预后不良相关：1）发热持续时间（包括复发期）超过10天；2）脑成像检查结果异常，如脑梗死、脑出血、脑脓肿和硬膜下积液；3）初始血清C反应蛋白值高于16mg/dl；4）初始脑脊液葡萄糖值低于12mg/dl；5）初始脑脊液乳酸脱氢酶值高于220IU/l。肺炎链球菌感染的预后最差：两例死亡病例的病原体均为肺炎链球菌。与流感嗜血杆菌（46.7%）和B族链球菌（25.0%）所致的脑膜炎相比，肺炎链球菌性脑膜炎预后不良的发生率也较高（60.0%）。在未检测到病原体的病例中，这一发生率低至10%，与检测到病原体的病例相比有显著差异。为了改善细菌性脑膜炎的预后，应在疾病早期识别出与预后不良相关的因素。
