Lopez E L, Devoto S, Fayad A, Canepa C, Morrow A L, Cleary T G
Division of Infectious Diseases, Hospital de Niños Ricardo Gutierrez, Buenos Aires, Argentina.
J Pediatr. 1992 Feb;120(2 Pt 1):210-5. doi: 10.1016/s0022-3476(05)80429-9.
To determine whether severity of the prodromal gastrointestinal illness is associated with the course and complications of the extraintestinal manifestations of hemolytic-uremic syndrome, we conducted a retrospective review of children (n = 509) hospitalized with hemolytic-uremic syndrome. Those who came to the hospital with colitis and rectal prolapse associated with hemolytic-uremic syndrome (group I, n = 40) were compared with an equal number of time-matched children with hemolytic-uremic syndrome but without prolapse (group II). Children in group I had evidence of more severe colitis than children in group II had, as indicated by increased frequency of bloody diarrhea (p less than 0.001) and longer duration of diarrhea (p less than 0.001). However, they also had more severe extraintestinal manifestations during hemolytic-uremic syndrome, including edema (p less than 0.0001), severe thrombocytopenia (p less than 0.0001), prolonged anuria (p less than 0.001), and seizures (p = 0.036). Long-term prognosis for recovery of renal function was worse for group I than group II. Within group II, patients with bloody diarrhea had milder extraintestinal illness than those with prolapse but more severe extraintestinal illness than those with watery diarrhea. Analysis of Kaplan-Meier survival curves demonstrated a better prognosis for return of normal renal function in the children with watery diarrhea but without prolapse (p = 0.009) than in children with bloody diarrhea or prolapse. These data demonstrate that the severity of the gastrointestinal prodrome reflects the severity of the extraintestinal acute microangiopathic process and the resulting long-term outcome. Widespread vascular damage, often followed by permanent sequelae, is characteristic of patients with the most severe colitis.
为了确定前驱性胃肠疾病的严重程度是否与溶血尿毒综合征肠外表现的病程及并发症相关，我们对509例因溶血尿毒综合征住院的儿童进行了回顾性研究。将因溶血尿毒综合征合并结肠炎及直肠脱垂前来就诊的患儿（第一组，n = 40）与同等数量的、年龄匹配的无直肠脱垂的溶血尿毒综合征患儿（第二组）进行比较。第一组患儿的结肠炎比第二组患儿更为严重，表现为血便频率增加（p < 0.001）及腹泻持续时间延长（p < 0.001）。然而，他们在溶血尿毒综合征期间也有更严重的肠外表现，包括水肿（p < 0.0001）、严重血小板减少（p < 0.0001）、无尿期延长（p < 0.001）及惊厥（p = 0.036）。第一组患儿肾功能恢复的长期预后比第二组更差。在第二组中，血便患儿的肠外疾病比直肠脱垂患儿轻，但比水样腹泻患儿重。Kaplan-Meier生存曲线分析表明，水样腹泻但无直肠脱垂的患儿肾功能恢复正常的预后（p = 0.009）优于血便或直肠脱垂患儿。这些数据表明，胃肠道前驱症状的严重程度反映了肠外急性微血管病变过程的严重程度及最终的长期预后。广泛的血管损伤，常伴有永久性后遗症，是最严重结肠炎患者的特征。
