【摘要】 目的 探讨儿童肺炎链球菌脑膜炎的临床特征。方法 回顾性分析西安市儿童医院神经内科2018年1月1日至2021年12月31日收治的14例肺炎链球菌脑膜炎患儿的临床及实验室资料。结果 14例患儿中，男9例，女5例；年龄≤1岁3例，>1～3岁4例，>3～5岁3例，>5岁4例；发病时间以上年度10月份至次年度1月份为主。患儿的主要临床表现为发热、头痛、呕吐、惊厥、脑膜刺激征阳性等。12例患儿的外周血白细胞计数不同程度升高，1例患儿出现外周血白细胞计数显著降低。所有患儿的脑脊液白细胞计数、血清降钙素原和C反应蛋白水平均升高。12例患儿的脑脊液葡萄糖测定水平降低。13例患儿的脑脊液蛋白定量升高。分离的细菌对四环素、红霉素、青霉素的耐药率达100.00%，对万古霉素、利奈唑胺、氯霉素及左氧氟沙星的敏感率为100.00%，对头孢曲松和头孢噻肟的耐药率分别为46.15%及53.85%。所有患儿入院后均给予抗感染、降低颅内压、维持水电解质平衡和保护脏器等综合治疗，其中大部分应用头孢曲松联合万古霉素治疗。治疗后，12例治愈或好转，1例遗留有脑积水，1例复发。结论 肺炎链球菌脑膜炎男童较女童多见，发病时间主要集中在上年度10月份至次年度1月份，不同年龄段儿童的临床表现有所差异，患儿外周血炎性指标比较敏感，但外周血白细胞计数显著降低可能为预后不良的独立危险因素，治疗宜早期使用万古霉素。更多还原

【Abstract】 Objective To investigate the clinical characteristics of Streptococcus pneumoniae meningitis in children.Methods The clinical and laboratory data of 14 children with Streptococcus pneumoniae meningitis admitted in the neurology department of Xi’an Children’s Hospital from January 1, 2018 to December 31, 2021 were analyzed retrospectively. Results Among the 14 children, there were 9 boys and 5 girls. 3 cases ≤1 year old, 4 cases >1-3 years old, 3 cases >3-5 years old, 4 cases >5 years old. The onset time of children is mainly from October of the previous year to January of the next year. The main clinical manifestations of children were fever, headache, vomiting, convulsion, positive meningeal irritation sign, etc. The white blood cell count in peripheral blood of 12 children increased in varying degrees,and the white blood cell count in peripheral blood significantly decreased in a child. The white blood cell count in cerebrospinal fluid, serum procalcitonin and C-reactive protein levels increased in all children. The level of glucose in cerebrospinal fluid decreased in 12 children. The protein quantification in cerebrospinal fluid increased in 13 children. The resistance rates of the isolated bacteria to tetracycline, erythromycin and penicillin were 100.00%, the sensitivity rates to vancomycin, linezolid, chloramphenicol and levofloxacin were 100. 00 %, and the resistance rates to ceftriaxone and cefotaxime were 46.15% and 53.85%, respectively. All children were given comprehensive treatment such as anti-infection,reducing intracranial pressure, maintaining water electrolyte balance and protecting organs after admission, most of the children were treated with ceftriaxone combined with vancomycin. After treatment, 12 cases were cured or improved, 1 case had hydrocephalus and 1 case had recurrence. Conclusion Streptococcus pneumoniae meningitis is more common in boys than that in girls, and its onset time is mainly from October of the previous year to January of the next year. There are differences in clinical manifestations among the children of different ages. The inflammatory index of peripheral blood in children is more sensitive. However, the significant decrease of white blood cell count in peripheral blood may be an independent risk factor for poor prognosis, vancomycin should be used early in treatment.更多还原