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在发达国家细菌性脑膜炎(BM)仅占急性脑膜炎的4%~6%,但延误诊治有引起死亡或严重神经后遗症的风险。鉴别儿童BM与病毒性脑膜炎(VM),有助于减少抗菌药物使用和/或住院。已发表鉴别儿童BM和VM的临床决策规则中,只有BM评分(BMS)经来自同一中心的内部验证和多中心的外部验证,具有敏感性高、特异性好、易于使用的特点。BMS由5个易于获得、客观的参数组成:脑脊液(CSF)革兰染色阳性、CSF蛋白质﹥0.8g/L、外周血中性粒细胞绝对计数(ANC)﹥10×109/L、惊厥、CSFANC﹥1000×106/L。革兰染色阳性评2分,其余每个参数阳性评1分。BMS可以准确鉴别BM极低风险(BMS=0)和高风险(BMS≥2),预测BM敏感性为98.3%~100%、特异性为52%~73%。极低风险患儿可不用抗菌药物门诊管理。
Bacterial meningitis (BM) accounts for only 4% to 6% of acute meningitis in developed countries, but the delay in diagnosis and treatment has the risk of causing death or serious neurological sequelae. Identifying children with viral meningitis (VM) helps to reduce the use of antibiotics and / or hospitalization. Of the clinical decision rules that have been published to identify children with BM and VM, only the BM score (BMS) is internally sensitive and multicenter externally validated from the same center and is highly sensitive, specific and easy to use. BMS consisted of five readily available and objective parameters: cerebrospinal fluid (CSF) positive for Gram stain, CSF protein> 0.8 g / L, absolute neutrophil count (ANC)> 10 × 109 / L, convulsion, CSFANC > 1000 × 106 / L. Gram stain positive score 2 points, the rest of each parameter positive score 1 point. BMS can accurately identify the very low risk of BM (BMS = 0) and high risk (BMS≥2), the sensitivity of prediction of BM is 98.3% ~ 100% and the specificity is 52% ~ 73%. Very low risk children may not be antibiotic clinic management.