Siegler R L, Pavia A T, Christofferson R D, Milligan M K
Division of Nephrology, University of Utah School of Medicine, Salt Lake City 84132.
Pediatrics. 1994 Jul;94(1):35-40.
To determine epidemiologic features, trends in frequency, and predictors of clinical outcome of postdiarrheal hemolytic uremic syndrome (HUS) in Utah.
A 20-year population-based study of HUS with a review of the HUS registry, hospital records, transplant registry, and a survey of pediatricians and pediatric nephrologists to ensure completeness of ascertainment.
All Utah residents under 18 years of age with HUS occurring after a diarrheal prodrome between 1971 and 1990.
Incidence of HUS, severity, complications, and long-term sequelae.
There were 157 cases during 20 years; 140 (89%) occurred after a diarrheal prodrome. The mean annual incidence was 1.42/100,000 children (range 0.2 to 3.4/100,000 children/year). Periods of high incidence occurred; however, there was no overall sustained increase in incidence. Escherichia coli O157:H7 was isolated from the stool of 62% of children who had specimens submitted. There were no differences between the first and second decade in the proportion with diarrheal prodrome, bloody diarrhea, most abnormal laboratory values, hospital course, or outcome. However, admission laboratory abnormalities were more severe during the first decade suggesting a delay in diagnosis. Age < 2 years, anuria before admission, and higher white blood cell counts on admission predicted severe disease. Bad outcome (death, end-stage renal disease, or stroke) occurred in 11%; 5% died. Chronic renal sequelae, usually mild, were found on follow-up (median 6.5 years) in 51% of survivors.
HUS has been an important clinical and public health problem in Utah for 20 years. The consistency of the clinical and epidemiologic features over 2 decades suggests that a common etiologic agent has accounted for most cases of HUS in this region since 1971.
确定犹他州腹泻后溶血尿毒综合征（HUS）的流行病学特征、发病率趋势及临床结局的预测因素。
一项基于人群的20年HUS研究，回顾HUS登记处、医院记录、移植登记处，并对儿科医生和儿科肾病学家进行调查以确保确诊的完整性。
1971年至1990年间，所有18岁以下腹泻前驱症状后发生HUS的犹他州居民。
HUS发病率、严重程度、并发症及长期后遗症。
20年间共157例；140例（89%）发生于腹泻前驱症状后。年平均发病率为1.42/10万儿童（范围0.2至3.4/10万儿童/年）。有高发期；但发病率无总体持续上升。62%送检标本的儿童粪便中分离出大肠杆菌O157:H7。腹泻前驱症状、血性腹泻、多数异常实验室值、住院病程或结局在第一个十年和第二个十年间无差异。然而，第一个十年入院时实验室异常更严重，提示诊断延迟。年龄<2岁、入院前无尿及入院时白细胞计数较高提示病情严重。不良结局（死亡、终末期肾病或中风）发生率为11%；5%死亡。随访（中位时间6.5年）发现51%幸存者有慢性肾脏后遗症，通常较轻。
20年来，HUS一直是犹他州重要的临床和公共卫生问题。20年间临床和流行病学特征的一致性表明，自1971年以来，一种常见病原体导致了该地区大多数HUS病例。
