细菌仍能给发育中的脑膜炎患儿大脑带来明显损害
2012-06-16 23:30:31 来源：
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Parents of infants who survive bacterial meningitis caused by group B Streptococcus might have to live with the effects of the disease on their children long after they're discharged from the hospital.
即使在出院以后，B组链球菌脑膜炎患儿的父母仍然要在在很长时间内承受该病的并发症所带来的痛苦。
A new study in the journal Pediatrics finds that even though mortality rates of children infected with GBS meningitis have decreased in the past 25 years, just under half of children who survive the disease will suffer impairment as a result of the disease.
发表在儿科学杂志的一项研究指出，尽管在过去25年间链球菌脑膜炎患儿的死亡率有所下降，仍然有接近一半的患儿要承受该病并发症带来的痛苦。
"These bacteria can quickly cause significant damage to the developing infant brain very quickly despite the infant's having received excellent medical care," says Morven S. Edwards, M.D., professor of Pediatrics at Baylor College of Medicine and a co-author on the paper.
该文的共同作者，来自Baylor医学院的儿科教授Morven S. Edwards, M.D.指出：即使治疗得当，细菌仍能给发育中的患儿大脑带来明显损害。
"This is a potentially devastating illness and we still have a large percentage of infants who have poor outcomes after the infection."
这是一个潜在毁灭性的疾病，仍有相当比例的患儿预后不佳。
According to the CDC, 25 percent of pregnant women carry GBS. It is routine for these women to receive antibiotics during labor to protect the baby from infection occurring in the first days of life. There is no way to prevent late-onset GBS infections in infants.
CDC指出大约有25%的孕妇携带有B族链球菌。常规做法是让这些孕妇在分娩期间口服抗菌素以防止婴儿早期发病。对于后期感染无法预防。
"We haven't had recent data on the outcomes of GBS meningitis in over 25 years and the quality of medical care has changed," says Prachi Shah, M.D., a clinical assistant professor at the University of Michigan Medical School Department of Pediatrics and Communicable Diseases, and a senior author on the paper. "We wanted to know, in this era of using antibiotics during birth, whether outcomes have changed for infants who do acquire GBS meningitis. Our study counsels families to be very vigilant about their child if they've had GBS."
虽然救治水平发生了改变，然而我们却没有最近超过25年的临床预后数据，密歇根大学儿科和传染病系助 理教授、文章的主要作者Prachi Shah, M.D.指出，我们想研究在现今出生应用抗生素预防的前提下，链球菌脑膜炎患儿的预后是否发生了改变。研究结果提示链球菌患儿的家庭要提高警惕。
The current study shows that, although modern day medicine has improved survival rates, children can still suffer adverse long-term outcomes.
研究认为，尽管现代的医疗手段提高了存活率，但是患儿远期预后仍然不尽如人意。
"Despite the fact that mortality has decreased in the last 25 years, survivors of GBS meningitis continue to have substantial long-term morbidity," says Romina Libster, M.D., a physician in the Department of Pediatrics at Vanderbilt University and first author on the paper.
Vanderbilt大学儿科医生、文章第一作者Romina Libster, M.D.认为，尽管在过去25年间死亡率下降，但是链球菌脑膜炎存活者发病率仍相当高。
The overall impact of invasive GBS infection in infants is just over 2,000 cases per year in the United States. Among those with bloodstream infection, 10 to 20 percent can also develop meningitis.
在美国，每年有2000例侵袭性B族链球菌感染发生。其中10-20%的血流感染者会发生脑膜炎。
The relative importance of GBS as a cause of meningitis has grown in recent years. "GBS is responsible for over 85 percent of bacterial meningitis in children under two months of age," says Edwards. "Vaccination with the newer pneumococcal vaccines has led to tremendous reductions in meningitis from those bacteria."
B族链球菌感染引起脑膜炎的重要性最近逐渐引起人们的重视，2个月以内儿童细菌性脑膜炎85%是由B族链球菌感染引起的。爱德华指出，接种新的肺炎球菌疫苗能明显降低细菌性脑膜炎的发生。
Using three different and distinctly defined levels to measure functionality, researchers find that 56 percent of children who survived GBS meningitis went on to have age-appropriate (or normal) development, 25 percent had mild-to-moderate impairment and 19 percent had severe impairment.
将功能分为三种不同并且精确定义的水平，研究者发现56%的B族链球菌脑膜炎存活患儿发育正常，25%轻到中度受损，19%严重受损。
Signs of mild-to-moderate impairment include continual and significant academic underachievement as well as evidence of mild neurological or functional impairment. Indications of severe impairment include blindness, hearing loss, cerebral palsy, and significantly delayed development.
轻到中度受损的表现包括持续而明显的学习成绩不良同时伴有轻度神经和功能受损。严重损伤包括失明、听力丧失、大脑性瘫痪、明显发育迟缓。
According to lab data and cranial images at the time of discharge, there are a number of factors that can help predict the likelihood of long-term severe impairment in GBS meningitis survivors, including a failed hearing screening, an abnormal neurologic exam, and abnormal imaging of the head. However, data and imaging cannot as accurately predict children who will have mild impairments, according to the study.
根据出院时实验室检查结果和头颅影像学检查结果，包括听力筛查不佳、神经系统检查异常以及头部影像学检查异常等很多因素可以用来预测脑膜炎患儿发生远期严重损害的可能行大小。然而根据研究结果，上述数据还不能同样准确的预测患儿发生轻度损害的可能行。
"The more subtle developmental delays suggest that any child who has had GBS meningitis should have ongoing developmental evaluation," says Edwards, "so that problems can be identified early and addressed even before the child actually starts school so that the child has the best chance to fulfill their potential."
有些更细微的发育异常提示所有的B族链球菌脑膜炎患儿都应该不断接受发育水平评价以便早期甚至在入学前就进行干预，将患儿的潜能激发出来。
The study examined 43 survivors of GBS meningitis between the ages of three and 12 years. Patients were examined physically, neurologically, with hearing and vision screening, and were also assessed using standardized developmental assessments.
该研究对43为3到12岁之间的B族链球菌脑膜炎存活患儿进行了身体、神经系统、听力视力检查并应用标准发育评价标准进行评价。
Parents were also questioned on perceptions of their child's development. Parents of children who either had normal or severely impaired functionality are able to accurately identify their children as such.
同时询问父母关于孩子的认知能力。功能发育正常或严重受损的患儿父母能够能够做出与事实相符的的判断。
However, according to the report, parents of children with mild-to-moderate impairments are less likely to accurately label their child's developmental delay. Because of this, Shah suggests the importance of follow-up evaluations. "Parent self-report is not always an accurate identifier of children who have mild impairment," she says, "which is why survivors of GBS meningitis should receive long-term development surveillance."
然而，根据研究结果，发育轻到中度受损患儿的父母相对而言不能够准确评价其孩子的发育延迟。因此，Shah发育轻度受损的患儿的父母往往不能做出准确自我评价，应给予长期发育监测。
According to Edwards, there are two important steps to be taken moving forward. The first is the development of a vaccine for mothers so that the disease can be prevented altogether. "The other," Edwards says, "is just to enhance awareness of the consequences of the infection and of the need for its prevention."
爱德华认为，目前有两项重要工作亟须完成。一是研制用于孕妇的疫苗以彻底预防疾病。二是，提高对感染后果和预防重要性的认识。
即使在出院以后，B组链球菌脑膜炎患儿的父母仍然要在在很长时间内承受该病的并发症所带来的痛苦。
A new study in the journal Pediatrics finds that even though mortality rates of children infected with GBS meningitis have decreased in the past 25 years, just under half of children who survive the disease will suffer impairment as a result of the disease.
发表在儿科学杂志的一项研究指出，尽管在过去25年间链球菌脑膜炎患儿的死亡率有所下降，仍然有接近一半的患儿要承受该病并发症带来的痛苦。
"These bacteria can quickly cause significant damage to the developing infant brain very quickly despite the infant's having received excellent medical care," says Morven S. Edwards, M.D., professor of Pediatrics at Baylor College of Medicine and a co-author on the paper.
该文的共同作者，来自Baylor医学院的儿科教授Morven S. Edwards, M.D.指出：即使治疗得当，细菌仍能给发育中的患儿大脑带来明显损害。
"This is a potentially devastating illness and we still have a large percentage of infants who have poor outcomes after the infection."
这是一个潜在毁灭性的疾病，仍有相当比例的患儿预后不佳。
According to the CDC, 25 percent of pregnant women carry GBS. It is routine for these women to receive antibiotics during labor to protect the baby from infection occurring in the first days of life. There is no way to prevent late-onset GBS infections in infants.
CDC指出大约有25%的孕妇携带有B族链球菌。常规做法是让这些孕妇在分娩期间口服抗菌素以防止婴儿早期发病。对于后期感染无法预防。
"We haven't had recent data on the outcomes of GBS meningitis in over 25 years and the quality of medical care has changed," says Prachi Shah, M.D., a clinical assistant professor at the University of Michigan Medical School Department of Pediatrics and Communicable Diseases, and a senior author on the paper. "We wanted to know, in this era of using antibiotics during birth, whether outcomes have changed for infants who do acquire GBS meningitis. Our study counsels families to be very vigilant about their child if they've had GBS."
虽然救治水平发生了改变，然而我们却没有最近超过25年的临床预后数据，密歇根大学儿科和传染病系助 理教授、文章的主要作者Prachi Shah, M.D.指出，我们想研究在现今出生应用抗生素预防的前提下，链球菌脑膜炎患儿的预后是否发生了改变。研究结果提示链球菌患儿的家庭要提高警惕。
The current study shows that, although modern day medicine has improved survival rates, children can still suffer adverse long-term outcomes.
研究认为，尽管现代的医疗手段提高了存活率，但是患儿远期预后仍然不尽如人意。
"Despite the fact that mortality has decreased in the last 25 years, survivors of GBS meningitis continue to have substantial long-term morbidity," says Romina Libster, M.D., a physician in the Department of Pediatrics at Vanderbilt University and first author on the paper.
Vanderbilt大学儿科医生、文章第一作者Romina Libster, M.D.认为，尽管在过去25年间死亡率下降，但是链球菌脑膜炎存活者发病率仍相当高。
The overall impact of invasive GBS infection in infants is just over 2,000 cases per year in the United States. Among those with bloodstream infection, 10 to 20 percent can also develop meningitis.
在美国，每年有2000例侵袭性B族链球菌感染发生。其中10-20%的血流感染者会发生脑膜炎。
The relative importance of GBS as a cause of meningitis has grown in recent years. "GBS is responsible for over 85 percent of bacterial meningitis in children under two months of age," says Edwards. "Vaccination with the newer pneumococcal vaccines has led to tremendous reductions in meningitis from those bacteria."
B族链球菌感染引起脑膜炎的重要性最近逐渐引起人们的重视，2个月以内儿童细菌性脑膜炎85%是由B族链球菌感染引起的。爱德华指出，接种新的肺炎球菌疫苗能明显降低细菌性脑膜炎的发生。
Using three different and distinctly defined levels to measure functionality, researchers find that 56 percent of children who survived GBS meningitis went on to have age-appropriate (or normal) development, 25 percent had mild-to-moderate impairment and 19 percent had severe impairment.
将功能分为三种不同并且精确定义的水平，研究者发现56%的B族链球菌脑膜炎存活患儿发育正常，25%轻到中度受损，19%严重受损。
Signs of mild-to-moderate impairment include continual and significant academic underachievement as well as evidence of mild neurological or functional impairment. Indications of severe impairment include blindness, hearing loss, cerebral palsy, and significantly delayed development.
轻到中度受损的表现包括持续而明显的学习成绩不良同时伴有轻度神经和功能受损。严重损伤包括失明、听力丧失、大脑性瘫痪、明显发育迟缓。
According to lab data and cranial images at the time of discharge, there are a number of factors that can help predict the likelihood of long-term severe impairment in GBS meningitis survivors, including a failed hearing screening, an abnormal neurologic exam, and abnormal imaging of the head. However, data and imaging cannot as accurately predict children who will have mild impairments, according to the study.
根据出院时实验室检查结果和头颅影像学检查结果，包括听力筛查不佳、神经系统检查异常以及头部影像学检查异常等很多因素可以用来预测脑膜炎患儿发生远期严重损害的可能行大小。然而根据研究结果，上述数据还不能同样准确的预测患儿发生轻度损害的可能行。
"The more subtle developmental delays suggest that any child who has had GBS meningitis should have ongoing developmental evaluation," says Edwards, "so that problems can be identified early and addressed even before the child actually starts school so that the child has the best chance to fulfill their potential."
有些更细微的发育异常提示所有的B族链球菌脑膜炎患儿都应该不断接受发育水平评价以便早期甚至在入学前就进行干预，将患儿的潜能激发出来。
The study examined 43 survivors of GBS meningitis between the ages of three and 12 years. Patients were examined physically, neurologically, with hearing and vision screening, and were also assessed using standardized developmental assessments.
该研究对43为3到12岁之间的B族链球菌脑膜炎存活患儿进行了身体、神经系统、听力视力检查并应用标准发育评价标准进行评价。
Parents were also questioned on perceptions of their child's development. Parents of children who either had normal or severely impaired functionality are able to accurately identify their children as such.
同时询问父母关于孩子的认知能力。功能发育正常或严重受损的患儿父母能够能够做出与事实相符的的判断。
However, according to the report, parents of children with mild-to-moderate impairments are less likely to accurately label their child's developmental delay. Because of this, Shah suggests the importance of follow-up evaluations. "Parent self-report is not always an accurate identifier of children who have mild impairment," she says, "which is why survivors of GBS meningitis should receive long-term development surveillance."
然而，根据研究结果，发育轻到中度受损患儿的父母相对而言不能够准确评价其孩子的发育延迟。因此，Shah发育轻度受损的患儿的父母往往不能做出准确自我评价，应给予长期发育监测。
According to Edwards, there are two important steps to be taken moving forward. The first is the development of a vaccine for mothers so that the disease can be prevented altogether. "The other," Edwards says, "is just to enhance awareness of the consequences of the infection and of the need for its prevention."
爱德华认为，目前有两项重要工作亟须完成。一是研制用于孕妇的疫苗以彻底预防疾病。二是，提高对感染后果和预防重要性的认识。
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