Mendoza-Guevara L, Cervantes A, Aguilar-Kitsu A, Rendon E, Morales A, Rodriguez F, Castro F, Flores M, Jaramillo R M, Garcia-Lopez E
Department of Nephrology, Hospital de Pediatria, Mexico City, Mexico.
Adv Perit Dial. 1997;13:285-90.
Uremic polyneuropathy (UPNP) is a serious complication of chronic renal failure (CRF) in adults; however, its prevalence is unknown in the pediatric population. An easy-to-perform maneuver for its detection in children is the evaluation of "H" reflex. The objective of this study was to validate the usefulness of the "H" reflex maneuver for the diagnosis of UPNP in pediatric dialysis patients for CRF. Thirty-seven CRF patients were paired with healthy controls by age and sex. The patients were being treated with dialysis or one of its variants. Information was obtained regarding diagnosis, duration, and control of dialysis. Neurological examination was performed, conduction velocities in sensory and motor nerves were measured, and "H" reflex elicited bilaterally. Peripheral polyneuropathy was determined by the presence of at least two nerves with alterations in latency and/or conduction velocities. It was found that 59.4% (22/37) of the children with CRF treated with dialysis developed UPNP, 17 with ambulatory peritoneal dialysis, and 5 with hemodialysis. There was no difference in diagnosis, duration of dialysis, or control of the same in these patients from other CRF patients who did not have UPNP. All patients were clinically asymptomatic. "H" reflex showed a sensibility of 44%, a specificity of 87%, a predictive value positive of 66%, and a predictive value negative of 76%, when measured to 28 msec. With a 30 msec duration specificity rises to 95%. UPNP presents asymptomatically in pediatric patients. "H" reflex is an adequate screening test for the selection of pediatric patients to be tested further.
尿毒症性多发性神经病（UPNP）是成人慢性肾衰竭（CRF）的一种严重并发症；然而，其在儿科人群中的患病率尚不清楚。一种在儿童中易于实施的检测方法是评估“H”反射。本研究的目的是验证“H”反射检测法对诊断儿科透析患者CRF相关性UPNP的有效性。37例CRF患者按年龄和性别与健康对照进行配对。这些患者正在接受透析或其变体治疗之一。获取了有关诊断、透析持续时间和透析控制情况的信息。进行了神经学检查，测量了感觉神经和运动神经的传导速度，并双侧引出“H”反射。外周多发性神经病通过至少两条神经的潜伏期和/或传导速度改变来确定。结果发现，接受透析治疗的CRF儿童中有59.4%（22/37）发生了UPNP，其中17例为非卧床腹膜透析，5例为血液透析。这些发生UPNP的患者与未发生UPNP的其他CRF患者在诊断、透析持续时间或透析控制方面没有差异。所有患者临床上均无症状。当测量到28毫秒时，“H”反射的敏感性为44%，特异性为87%，阳性预测值为66%，阴性预测值为76%。当持续时间为30毫秒时，特异性升至95%。UPNP在儿科患者中无症状出现。“H”反射是一种适用于筛选需进一步检查的儿科患者的筛查试验。
