Schlieper A, Orrbine E, Wells G A, Clulow M, McLaine P N, Rowe P C
Canadian Pediatric Kidney Disease Research Centre, Ottawa, Ontario, Canada.
Arch Dis Child. 1999 Mar;80(3):214-20. doi: 10.1136/adc.80.3.214.
Severe haemolytic uraemic syndrome (HUS) in childhood can cause stroke, hemiplegia, cortical blindness, and psychomotor retardation. These outcomes are evident at the time of discharge immediately after the acute illness. Less is known about the neuropsychological outcomes of less severely affected children who recover from acute HUS.
This multicentre case control study investigated the hypothesis that children who survive an acute episode of HUS without recognizable neurological injuries have greater impairment of cognitive, academic, and behavioural functions than controls.
Children with HUS were eligible if they had no evidence of severe neurological dysfunction when discharged from one of six Canadian hospitals. Controls had been admitted to hospital for a non-HUS illness and were matched by age, sex, first language, and socioeconomic status. All subjects underwent evaluation of behaviour, academic achievement, cognitive function, and verbal abilities using standardised tests administered by a psychometrist blinded to the case or control status.
Ninety-one case control pairs were enrolled. No important differences between patients with HUS and paired controls were evident on tests of IQ, behaviour, verbal abilities, or academic achievement. There was no increased risk of attention deficit disorder among patients with HUS. There was no correlation between the severity of acute renal failure and neuropsychological measures, although scores on some verbal ability tests were lower in those with the highest serum creatinine concentrations during illness.
Children discharged from hospital without apparent neurological injury after an episode of acute HUS do not have an increased risk of subclinical problems with learning, behaviour, or attention.
儿童严重溶血尿毒综合征（HUS）可导致中风、偏瘫、皮质盲和精神运动发育迟缓。这些后果在急性疾病刚结束出院时就很明显。对于从急性HUS中康复的受影响较轻的儿童的神经心理学后果了解较少。
这项多中心病例对照研究调查了这样一个假设，即经历急性HUS发作且无明显神经损伤的存活儿童，其认知、学业和行为功能的损害比对照组更大。
如果加拿大六家医院之一的HUS患儿出院时没有严重神经功能障碍的证据，则符合入选标准。对照组因非HUS疾病入院，并根据年龄、性别、第一语言和社会经济地位进行匹配。所有受试者均由对病例或对照状态不知情的心理测量师使用标准化测试对行为、学业成绩、认知功能和语言能力进行评估。
共纳入91对病例对照。在智商、行为、语言能力或学业成绩测试中，HUS患者与配对对照组之间没有明显差异。HUS患者患注意力缺陷障碍的风险没有增加。急性肾衰竭的严重程度与神经心理学指标之间没有相关性，尽管在患病期间血清肌酐浓度最高的患者中，一些语言能力测试的分数较低。
急性HUS发作后出院时无明显神经损伤的儿童，出现学习、行为或注意力亚临床问题的风险没有增加。
