摘要
目的探讨儿童肺炎链球菌性与大肠杆菌性化脓性脑膜炎MRI表现特点。方法搜集2010年1月至2014年12月本院感染科收治的肺炎链球菌性及大肠杆菌性化脓性脑膜炎患儿共47例临床资料及MRI检查资料。采用χ2检验、Fisher精确概率法、t检验或秩和检验对两组患儿的临床及影像特征进行统计学分析,P<0.05认为具有统计学意义。结果肺炎链球菌组患儿共34例,1岁以下幼儿21例(61.8%),1岁以上13例(38.2%);大肠杆菌组13例,均为1岁以下。肺炎链球菌性脑膜炎多见于9~11个月(44%),大肠杆菌性脑膜炎多见于6~8个月(46%)。两种病原菌发病时间分布有明显统计学差异(P=0.01)。肺炎链球菌与大肠杆菌性脑膜炎的临床表现在发热、意识改变这两项(P=0.036)具有统计学差异。两组硬膜下积液发生概率及分布情况无明显统计学差异(P>0.05),大肠杆菌组较肺炎链球菌组硬膜下出血或积脓(50%vs.27.2%)概率略高。大肠杆菌组较肺炎链球菌组侧脑室积脓(8.3%vs.3.3%)、室管膜炎(16.7%vs.3.3%)更为多见,而肺炎链球菌组侧脑室旁水肿更为多见。肺炎链球菌组较大肠杆菌组软脑膜及硬脑膜增厚(56.7%vs.41.7%)概率略高,分布广泛,且伴随明显的血管流空信号增多(56.7%),但大肠杆菌组硬脑膜增厚程度略高。肺炎链球菌组较大肠杆菌组脑实质异常信号累及范围更广,脑出血更常见且伴有静脉窦血栓形成。结论肺炎链球菌性脑膜炎发病年龄大,冬季常见,易出现发热和意识改变,以清亮大量硬膜下积液伴脑积水、大范围脑膜受累伴大脑表面血管增多为主要特征,脑实质出血、坏死、软化、脓肿形成显著,且易伴随静脉窦血栓形成;而大肠杆菌性脑膜炎发病年龄小,夏天多见,易抽搐,以浑浊硬膜下积液伴室管膜炎、局部脑膜明显增厚为特征改变。
Objective To investigate the MRI neuroimaging in the children with pneumococcal meningitis or E.coli meningitis.Methods Systematic review were performed on the clinical data and MRI neuroimaging features of 47 cases of pediatric pneumococcal meningitis or E.coli meningitis admitted to the infectious department of our hospital from January 2010 to December 2014 retrospectively.Parameters were compared between the two groups by using Chi-square or Fisher’s exact tests and Wilcoxon tests were appropriate.Results 34 children with pneumococcal meningitis were included.21 of them were under the age of 1(61.8%)and 13 children were older than 1 year old(38.2%).All the 13 children with E.coli meningitis group were under the age of 1 year old.Pneumococcal meningitis was more common from September to November(44%).E.coli meningitis was more common from June to August(46%).The significant difference was shown on prevalent period of the two pathogens(P=0.01).A statistical difference was found in fever and altered consciousness(P=0.036).There was no significant difference in the probability and distribution of subdural effusion between the two bacterial groups(P>0.05).The probability of subdural hemorrhage or empyema in E.coli group was slightly higher than that in Pneumococcal group(50%:27.2%).Lateral ventricular empyema(8.3%:3.3%)and ependymitis(16.7%:3.3%)were more common in E.coligroup,while paraventricular edema(30%)was more common in Pneumococcal group.The probability of meningeal thickening was slightly higher(56.7%:41.7%)with widely distributed in Pneumococcal group accompanied by increase of vessel signal(56.7%).While the endocraniumof E.coli group markedly became thick.The abnormal signal in brain parenchyma like cerebral hemorrhage(6.7%)and venous sinus thrombosis(6.7%)were more common in Pneumococcal group.Conclusion Pneumococcal meningitis commonly occured in older children in winter,which was prone to fever and alteration of consciousness.It is prone to fever and changes in consciousness.It is mainly characterized by clear and large subdural effusion with hydrocephalus,large-scale meningeal involvement with increased cerebral surface vascularity and parenchymal hemorrhage.Pneumococcal meningitis had a higher propensity of necrosis,leukomalacia,abscess formation and venous sinus thrombosis.Escherichia coli meningitis commonly occurred in summer predominantly among infants,which was prone to resulting in convulsions.Turbid subdural effusion with ependymitis and marked meningeal thickening were the characteristic manifestations of Escherichia coli meningitis.
作者
胡迪
郜英子
李航
陶晓娟
刘志敏
于彤
刘钢
彭芸
HU Di;GAO Yingzi;LI Hang(Department of Radiology,Beijing Children’s Hospital,Capital Medical University,National Center for Children’s Health,Beijing 100045,P.R.China)
出处
《临床放射学杂志》
CSCD
北大核心
2020年第11期2304-2309,共6页
Journal of Clinical Radiology
基金
北京市医院管理中心“青苗”计划专项经费资助(编号:QML20181203)
北航-首医大数据精准医疗高精尖创新中心计划资助(编号:BHME-201802)
关键词
化脓性脑膜炎
肺炎链球菌
大肠杆菌
儿童
磁共振成像
Purulent meningitis
Streptococcus pneumoniae
Escherichia coli
Children
Magnetic resonance imaging
