Garg Amit X, Moist Louise, Matsell Douglas, Thiessen-Philbrook Heather R, Haynes R Brian, Suri Rita S, Salvadori Marina, Ray Joel, Clark William F
Division of Nephrology, University of Western Ontario, London, Ont.
CMAJ. 2005 Aug 2;173(3):261-8. doi: 10.1503/cmaj.050581. Epub 2005 May 27.
The long-term health consequences of acute bacterial gastroenteritis remain uncertain. We studied the risk of hypertension and reduced kidney function after an outbreak of acute gastroenteritis due to contamination of a regional drinking water supply with Escherichia coli O157:H7 and Campylobacter species.
A total of 1958 adults with no known history of hypertension or kidney disease before the outbreak participated in a long-term follow-up study. Of the participants, 675 had been asymptomatic during the outbreak, 909 had had moderate symptoms of acute self-limited gastroenteritis, and 374 had had severe symptoms that necessitated medical attention. The outcomes of interest were a diagnosis of hypertension or the presence of reduced kidney function and albuminuria during the follow-up period.
After a mean follow-up of 3.7 years after the outbreak, hypertension was diagnosed in 27.0% of participants who had been asymptomatic during the outbreak and in 32.3% and 35.9% of those who had had moderate and severe symptoms of acute gastroenteritis respectively (trend p = 0.009). Compared with the asymptomatic participants, those with moderate and severe symptoms of gastroenteritis had an adjusted relative risk of hypertension of 1.15 (95% confidence interval [CI] 0.97-1.35) and 1.28 (95% CI 1.04-1.56) respectively. A similar graded association was seen for reduced kidney function, defined as the presence of an estimated glomerular filtration rate below 60 mL/min per 1.73 m2 (trend p = 0.03). No association was observed between gastroenteritis and the subsequent risk of albuminuria.
Acute bacterial gastroenteritis necessitating medical attention was associated with an increased risk of hypertension and reduced kidney function 4 years after infection. Maintaining safe drinking water remains essential to human health, as transient bacterial contaminations may have implications well beyond a period of acute self-limited illness.
急性细菌性肠胃炎的长期健康后果仍不明确。我们研究了因地区饮用水供应被大肠杆菌O157:H7和弯曲杆菌属污染而引发急性肠胃炎疫情后发生高血压和肾功能减退的风险。
共有1958名在疫情爆发前无高血压或肾病病史的成年人参与了一项长期随访研究。在这些参与者中，675人在疫情期间无症状，909人有急性自限性肠胃炎的中度症状，374人有严重症状且需要就医。感兴趣的结局是随访期间高血压的诊断或肾功能减退及蛋白尿的存在情况。
疫情爆发后平均随访3.7年，疫情期间无症状的参与者中有27.0%被诊断为高血压, 急性肠胃炎有中度和重度症状的参与者中这一比例分别为32.3%和35.9%（趋势p = 0.009）。与无症状参与者相比，肠胃炎有中度和重度症状的参与者发生高血压的校正相对风险分别为1.15（95%置信区间[CI] 0.97 - 1.35）和1.28（95% CI 1.04 - 1.56）。对于定义为估计肾小球滤过率低于60 mL/（min·1.73 m²）的肾功能减退，也观察到了类似的分级关联（趋势p = 0.03）。未观察到肠胃炎与随后发生蛋白尿风险之间的关联。
需要就医的急性细菌性肠胃炎与感染后4年高血压风险增加和肾功能减退有关。保持安全的饮用水对人类健康仍然至关重要，因为短暂的细菌污染可能产生远超急性自限性疾病时期的影响。
