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目的分析产单核细胞李斯特菌感染的临床和实验室特点,以期为李斯特菌感染的临床诊断和治疗提供一定的依据。方法回顾性分析2012年1月至2016年10月间四川大学华西医院收治的26例产单核细胞李斯特菌败血症和脑膜炎患者的临床资料和实验室检查,同时收集26例其他细菌性脑膜炎患者的脑脊液检查结果作为对照。结果 26例产单核细胞李斯特菌感染的患者中,14例为败血症,12例为脑膜炎。年龄大于50岁的患者居多,占46.2%。22例住院患者中18例(81.8%)患有基础疾病,9例(40.9%)患者曾接受过糖皮质激素或者免疫抑制剂治疗。20例确诊后经治疗的患者中,17例好转出院,3例预后不佳,30.0%(共6例,好转患者4例,预后不佳2例)的患者接受了不恰当的经验性治疗。脑脊液检查结果显示产单核细胞李斯特菌脑膜炎患者脑脊液白细胞和蛋白质升高,葡萄糖降低,58.3%以多个核细胞增多为主。与其他细菌性脑膜炎相比,产单核细胞李斯特菌脑膜炎患者脑脊液白细胞、蛋白质和氯水平差异无统计学意义(P>0.05),但葡萄糖水平更高(P=0.001)。结论产单核细胞李斯特菌的感染主要发生在免疫低下和老年人中。产单核细胞李斯特菌脑膜炎脑脊液检查可能缺乏典型的细菌性脑膜炎改变,脑脊液葡萄糖水平较正常水平降低不明显。
Objective To analyze the clinical and laboratory characteristics of Listeria monocytogenes infection in order to provide a basis for the clinical diagnosis and treatment of Listeria infection. Methods The clinical data and laboratory tests of 26 patients with Listeria monocytogenes and meningitis admitted to West China Hospital of Sichuan University from January 2012 to October 2016 were analyzed retrospectively. Twenty-six other bacterial meninges The result of cerebrospinal fluid test in patients with inflammation was used as a control. Results Among 26 patients with Listeria monocytogenes infection, 14 were sepsis and 12 were meningitis. The majority of patients older than 50 years old, accounting for 46.2%. Eighteen (81.8%) of the 22 inpatients had underlying disease and 9 (40.9%) had been treated with glucocorticoids or immunosuppressive agents. Of the 20 patients who were diagnosed, 17 were well discharged and 3 were poorly prognosed, and 30.0% (6 in total, 4 in remission, 2 in poor prognosis) received inappropriate empirical therapy. Cerebrospinal fluid tests showed elevated levels of leukocytes and proteins in cerebrospinal fluid in patients with Listeria monocytogenes, with a decrease in glucose, 58.3% predominating in multiple nucleated cells. Compared with other bacterial meningitis, the levels of leukocyte, protein and chlorine in cerebrospinal fluid of patients with Listeria monocytogenes were not significantly different (P> 0.05), but glucose levels were higher (P = 0.001). Conclusion Listeria monocytogenes infection mainly occurs in immunocompromised and elderly. Listeria monocytogenes cerebrospinal fluid examination may lack the typical changes of bacterial meningitis, cerebrospinal fluid glucose levels lower than normal is not obvious.