关键词: 婴儿, 化脓性脑膜炎, 临床特征, 预测因子

Abstract: Objective We aimed to analyze the clinical characteristics of community acquired purulent meningitis(PM) in infants and explore the predictors of early diagnosis. Methods Retrospective study was done with patients in our NICU from Jan 2015 to Dec 2017 aged during 29 days to 90 days. We divided them into two groups, 53 of which diagnosed PM were included as a case group, while 81 of which admitted inpatients with fever at the same periods and in the same age ranges were included as a control group. Factors including adverse basic events, clinical manifestations, laboratory examinations and so on were compared between two groups. Results Univariate analysis showed that premature, manifestations such as irritability, lethargy, bulging fontanelle,a stiff neck and the poor circulation, and cerebrospinal fluid(CSF) data like the mount of white blood cell, concentration of CSF protein, concentration of CSF glucose, CSF/blood glucose ratio, concentration of CSF lactate dehydrogenase were different between two groups. In the multivariate analysis, concentration of CSF Protein(＞0.450 g/L, OR=5.819, P=0.002) and concentration of CSF lactate dehydrogenase(＞28.300 U/L,OR=7.892, P＜0.001) were proven to be independent risk factors for the diagnosis of PM. Receiver operating characteristic (ROC) analysis revealed that the CSF protein, the CSF lactate dehydrogenase and the combination of the two factors had an increased area under the curve (AUC), the mounts of each which were 0.839,0.867 and 0.890. Conclusion Patients with PM in early infantile period are often lack of atypical clinical characteristics. We need pay highly attention to the adverse basic events, irritability, lethargy, bulging fontanelle,a stiff neck, poor circulation and CSF results. The independent predictors for early diagnosis were concentration of CSF protein and lactate dehydrogenase. It indicates that if the predictors could be identified early, diagnosis could be made timely and interventions could be operated immediately. It will be beneficial for progression-free and overall survival.

Key words: Infant, Purulent meningitis, Clinical characteristics, Predictor