新生儿化脓性脑膜炎继发MRI颅脑结构异常的临床特点及危险因素分析

Analysis of clinical features and risk factors of craniocerebral structural abnormalities on head MRI following neonatal purulent meningitis

摘要

目的 分析新生儿化脓性脑膜炎继发磁共振成像(MRI)颅脑结构异常患儿的临床特点及相关高危因素.方法 选取2018年1月至2023年12月在徐州市儿童医院新生儿重症监护病房(NICU)住院且诊断为化脓性脑膜炎的152例新生儿为研究对象,根据治疗后的头颅MRI是否存在颅脑结构异常分为异常组与正常组,通过查阅电子病历、影像学系统收集患儿相关临床资料.多因素Logistic回归分析新生儿化脓性脑膜炎合并MRI结构异常的影响因素.结果 新生儿化脓性脑膜炎继发颅脑MRI结构异常比例为20.39%(31/152),异常类型以颅内出血、硬膜下积液、脑室异常(扩大或积水)为主;异常组患儿吃奶减少、嗜睡/激惹、惊厥发作、早发型脑膜炎、有创呼吸支持占比高于正常组,差异有统计学意义(χ²值介于3.884~25.438之间,P＜0.05);异常组降钙素原(PCT)、血液C反应蛋白(CRP)、白介素-6(IL-6)及脑脊液(CSF)细胞数、中性比例、蛋白水平高于正常组,CSF葡萄糖水平低于正常组,差异有统计学意义(Z值介于2.227~5.081之间,P＜0.05);异常组与正常组主要病原学均为大肠埃希菌、B群无乳链球菌,异常组总培养阳性率及脑脊液阳性率、血培养阳性率均高于正常组(χ²值分别为9.165、10.330、4.960,P＜0.05),两组革兰氏阳性菌与阴性菌检出无统计学差异(P＞0.05);多因素Logistic回归结果显示CRP、CSF蛋白增高、早发型脑膜炎、惊厥发作、有创呼吸支持为新生儿化脓性脑膜炎MRI结构异常的独立影响因素(OR值介于1.028~133.553之间,P＜0.05).结论 新生儿化脓性脑膜炎继发颅脑MRI结构异常发生率仍较高,应重视头颅MRI在新生儿化脓性脑膜炎中的应用,提高对新生儿化脓性脑膜炎继发颅脑MRI异常的高危因素及不良预后的认识.

Abstract

Objective To analyze clinical features and related high-risk factors of craniocerebral structural abnormalities on magnetic resonance imaging (MRI) following neonatal purulent meningitis (NPM). Methods 152 neonates who hospitalized and were diagnosed as NPM in Neonatal Intensive Care Unit (NICU) of The Affiliated Xuzhou Children's Hospital of Jiangsu Medical University from January 2018 to December 2023 were selected as study subjects. According to whether the neonate had abnormality in craniocerebral structure on head MRI after treatment, the neonates were divided into two groups: abnormal MRI group and normal MRI group. The clinical data of the neonates were collected from electronic medical records and imaging system. Multiple Logistic regression was used to analyze risk factors of craniocerebral structural abnormalities on MRI following NPM. Results The abnormal rate of craniocerebral structure on head MRI was 20.39% (31/152), intracranial haemorrhage, subdural effusion, ventricular abnormality (ventriculomegaly or hydrocephalus) were three main types of craniocerebral structural abnormalities. In the abnormal MRI group, proportions of decreased daily milk consumption, drowsiness/irritation, seizure onset, early-onset meningitis and invasive ventilator support were higher than those in the normal MRI group, and the differences were statistically significant (χ ²=3.884-25.438, all P＜0.05). Also, the serum levels of C-reactive protein (CRP), procalcitonin (PCT) and interleukin-6 (IL-6) in blood and counts of white blood cells (WBC) and proteins in cerebrospinal fluid (CSF) of the neonates in the abnormal MRI group were higher than those in the normal MRI group, while content of glucose in CSF was lower than that in the normal MRI group, and the differences were statistically significant (Z=2.227-5.081, all P＜0.05). The most common pathogens of the neonates in the two groups were Escherichia coli (E. coli) and group B streptococcus (GBS). However, the total positive pathogenic bacteria culture rate, and the positive rates of pathogenic bacteria culture in CSF and in blood of the neonates in the abnormal MRI group were higher than those in the normal MRI group (χ ²=9.165, 10.330 and 4.960 respectively, all P＜0.05). There was no statistically significant difference in classification of pathogens (Gram-positive bacteria or Gram-negative bacteria) between the two groups (P＞0.05). Multiple Logistic regression analysis showed that, for neonates with craniocerebral structural abnormalities on head MRI following NPM, high level of CRP in blood, significantly increased content of protein in CSF, early-onset meningitis, seizure onset, invasive ventilator support were all independent risk factors (OR=1.028-133.553, all P＜0.05). Conclusions The incidence of craniocerebral structural abnormalities on head MRI following NPM relatively stays at high level. Head MRI examination for those neonates with purulent meningitis must be applied and the pediatricians' deep recognition on high-risk factors and poor prognosis of the disease should be improved.

关键词

新生儿 / 化脓性脑膜炎 / 颅脑MRI / 临床特点 / 危险因素

Key words

neonate / purulent meningitis / magnetic resonance imaging / clinical feature / risk factor

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基金资助

徐州市卫生健康委医学科技创新项目(XWKYHT20220087)