Tavasoli Azita, Zafaranloo Nazanin, Hoseini Rozita, Otukesh Hasan, Nakhaiee Shahrbanoo
Ali-Asghar Children Hospital, Iran University of Medical and Sciences, Tehran, Iran.
Med J Islam Repub Iran. 2021 Jul 17;35:91. doi: 10.47176/mjiri.35.91. eCollection 2021.
Diarrhea-associated-hemolytic-uremic-syndrome (D+HUS) is a common from of HUS. Central-nervous-system (CNS) involvement is one of the most common extrarenal organ involvements in children with D+HUS. This systematic review and meta-analysis aim to recognize the frequency of neurological complications in pts with HUS. Databases of PubMed, Embase, and Web of Science were searched systematically to find the papers on neurological involvement in HUS pts. Two researchers independently assessed the papers' quality and extracted data. CMA v. 2.2.064. was used for data analysis. Heterogeneity was evaluated using the I-squared (I2) test, and a fixed/random-effects model was used when appropriate. In this review, 21 studies including 2,189 participants with a median age between 1.3-40-year-old, entered the meta-analysis. The meta-analysis in D+HUS patients indicated 27.0% with neurological complications (95% CI, 22.0%-32.6%), 25.5% of symptoms weren't categorized (95% CI, 15.9%-38.3%), 20.8% of them developed the seizures (95% CI, 2.3%-74.4%). In D-HUS pts, 20.8% of them were presented neurological symptoms (95% CI, 17.9%-24.0%), of which 29.0% weren't categorized (95% CI, 19.2%-41.2%), 17.5% of pts got into coma (95% CI, 9.6%-29.7%), 5.6 % showed hemiparesis (95% CI, 2.8%-10.9%), 17.2% experienced lethargy (95% CI, 5.2%-44.1%), 30.5% developed the seizures (95% CI, 18.2%-46.2%), 7.4% manifested speech abnormalities (95% CI, 0.2%-7.22%), 6.4% of D-HUS pts presented visual-disturbances (95% CI, 3.4%-11.6%). This systematic review and meta-analysis indicated more than one-fourth of both D+HUS and D-HUS patients were presented with neurological symptoms, and the most prevalent symptoms were seizures, which can lead to an epilepsy sequel.
腹泻相关性溶血尿毒综合征（D+HUS）是溶血尿毒综合征的常见类型。中枢神经系统（CNS）受累是D+HUS患儿最常见的肾外器官受累情况之一。本系统评价和荟萃分析旨在明确溶血尿毒综合征患者神经并发症的发生率。系统检索了PubMed、Embase和Web of Science数据库，以查找有关溶血尿毒综合征患者神经受累的文献。两名研究人员独立评估文献质量并提取数据。使用CMA v. 2.2.064进行数据分析。采用I²检验评估异质性，并在适当情况下使用固定/随机效应模型。在本评价中，21项研究纳入荟萃分析，共2189名参与者，年龄中位数在1.3至40岁之间。对D+HUS患者的荟萃分析表明，27.0%有神经并发症（95%CI，22.0%-32.6%），25.5%的症状未分类（95%CI，15.9%-38.3%），20.8%出现癫痫发作（95%CI，2.3%-74.4%）。在非腹泻相关性溶血尿毒综合征（D-HUS）患者中，20.8%有神经症状（95%CI，17.9%-24.0%），其中29.0%未分类（95%CI，19.2%-41.2%），17.5%的患者昏迷（95%CI，9.6%-29.7%），5.6%表现为偏瘫（95%CI，2.8%-10.9%），17.2%出现嗜睡（95%CI，5.2%-44.1%），30.5%出现癫痫发作（95%CI，18.2%-46.2%），7.4%有言语异常（95%CI，0.2%-7.22%），6.4%的D-HUS患者有视觉障碍（95%CI，3.4%-11.6%）。本系统评价和荟萃分析表明，超过四分之一的D+HUS和D-HUS患者有神经症状，最常见的症状是癫痫发作，这可能导致癫痫后遗症。
