Suri Rita S, Clark William F, Barrowman Nick, Mahon Jeffrey L, Thiessen-Philbrook Heather R, Rosas-Arellano M Patricia, Zarnke Kelly, Garland Jocelyn S, Garg Amit X
Kidney Clinical Research Unit, Division of Nephrology, London Health Sciences Center, University of Western Ontario, Room ELL-111 Victoria Hospital, 800 Commissioners Rd. East, London, Ontario, Canada N6A 4G5.
Diabetes Care. 2005 Oct;28(10):2556-62. doi: 10.2337/diacare.28.10.2556.
To quantify the incidence of diabetes during the acute phase of diarrhea-associated hemolytic uremic syndrome (D + HUS) and to identify features associated with its development.
A systematic review and meta-analysis of articles assessing diabetes during D + HUS was conducted. Relevant citations were identified from Medline, Embase, and Institute for Scientific Information Citation Index databases. Bibliographies of relevant articles were hand searched. All articles were independently reviewed for inclusion and data abstraction by two authors.
Twenty-one studies from six countries were included. Only 2 studies reported a standard definition of diabetes; 14 defined diabetes as hyperglycemia requiring insulin. The incidence of diabetes during the acute phase of D + HUS could be quantified in a subset of 1,139 children from 13 studies (1966-1998, age 0.2-16 years) and ranged from 0 to 15%, with a pooled incidence of 3.2% (95% CI 1.3-5.1, random-effects model, significant heterogeneity among studies, P = 0.007). Children who developed diabetes were more likely to have severe disease (e.g., presence of coma or seizures, need for dialysis) and had higher mortality than those without diabetes. Twenty-three percent of those who developed diabetes acutely died, and 38% of survivors required long-term insulin (median follow-up 12 months). Recurrence of diabetes was possible up to 60 months after initial recovery.
Children with D + HUS should be observed for diabetes during their acute illness. Consideration should be given to long-term screening of D + HUS survivors for diabetes.
量化腹泻相关性溶血尿毒综合征（D+HUS）急性期糖尿病的发病率，并确定其发生相关特征。
对评估D+HUS期间糖尿病的文章进行系统评价和荟萃分析。从医学文献数据库（Medline）、荷兰医学文摘数据库（Embase）和科学信息研究所引文索引数据库中识别相关引文。对相关文章的参考文献进行手工检索。所有文章由两位作者独立评审以确定是否纳入及进行数据提取。
纳入了来自6个国家的21项研究。只有2项研究报告了糖尿病的标准定义；14项将糖尿病定义为需要胰岛素治疗的高血糖症。在13项研究（1966 - 1998年，年龄0.2 - 16岁）的1139名儿童亚组中可以量化D+HUS急性期糖尿病的发病率，范围为0至15%，合并发病率为3.2%（95%CI 1.3 - 5.1，随机效应模型，研究间存在显著异质性，P = 0.007）。发生糖尿病的儿童更可能患有严重疾病（如昏迷或惊厥、需要透析），且死亡率高于未患糖尿病的儿童。急性发生糖尿病的患儿中有23%死亡，38%的幸存者需要长期胰岛素治疗（中位随访12个月）。糖尿病在初次恢复后长达60个月都有可能复发。
D+HUS患儿在急性发病期间应观察是否发生糖尿病。应考虑对D+HUS幸存者进行糖尿病的长期筛查。
