Iijima Kazumoto, Kamioka Ichiro, Nozu Kandai
Department of Nephrology, National Children's Medical Center, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo 157-8535, Japan.
Clin Exp Nephrol. 2008 Feb;12(1):16-9. doi: 10.1007/s10157-007-0007-4. Epub 2008 Jan 5.
Most cases of diarrhea-associated hemolytic uremic syndrome (D+HUS) are caused by Shiga toxin-producing bacteria. Shiga toxin-producing Escherichia coli (STEC) O157:H7 has the strongest association worldwide with HUS. A massive outbreak of E. coli O157:H7 infections in Sakai, Osaka, Japan, in 1996 raised public and medical awareness of STEC. However, most cases are sporadic or occur in small clusters. Indeed, more than 100 sporadic or small cluster cases of D+HUS occur every year in Japan. The use of antibiotics in patients with definite or possible enteric STEC infections is controversial; however, there has been no randomized controlled trial to date showing the effectiveness of antibiotics for the prevention of the development of HUS. Thus, most investigators in western countries believe that antibiotics should not be administered to patients with such infections, and the management of HUS remains supportive. There are no specific therapies to ameliorate the course of the disease, and vascular injury leading to HUS is likely to be well under way by the time infected patients seek medical attention for diarrhea. The best way to prevent HUS is to prevent primary infection by Shiga toxin-producing bacteria.
大多数腹泻相关的溶血尿毒综合征（D+HUS）病例由产志贺毒素细菌引起。产志贺毒素大肠杆菌（STEC）O157:H7在全球范围内与溶血尿毒综合征的关联最为密切。1996年日本大阪堺市爆发的大规模大肠杆菌O157:H7感染事件提高了公众和医学界对产志贺毒素大肠杆菌的认识。然而，大多数病例为散发性或呈小范围聚集性发病。事实上，日本每年有超过100例散发性或小范围聚集性D+HUS病例。对于确诊或疑似肠道产志贺毒素大肠杆菌感染的患者使用抗生素存在争议；然而，迄今为止尚无随机对照试验表明抗生素对预防溶血尿毒综合征的发生有效。因此，西方国家的大多数研究者认为，不应给此类感染患者使用抗生素，溶血尿毒综合征的治疗仍以支持治疗为主。目前尚无改善疾病进程的特效疗法，当感染患者因腹泻就医时，导致溶血尿毒综合征的血管损伤可能已经很严重了。预防溶血尿毒综合征的最佳方法是预防产志贺毒素细菌的初次感染。
