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    Neurological involvement in children with E. coli O104:H4-induced hemolytic uremic syndrome

    发布于：2014年3月31日    文字：【大】【中】【小】

    Pediatr Nephrol. 2014 Mar 25

    Neurological involvement in children with E. coli O104:H4-induced hemolytic uremic syndrome

    Bauer A, Loos S, Wehrmann C, Horstmann D, Donnerstag F, Lemke J, Hillebrand G, L?bel U, Pape L, Haffner D, Bindt C,Ahlenstiel T, Melk A, Lehnhardt A, Kemper MJ, Oh J, Hartmann H.

    Abstract

    BACKGROUND:The aim of this study was to analyze the neurological involvement and outcome in pediatric patients with hemolytic uremic syndrome (HUS) during the 2011 epidemic caused by Escherichia coli O104:H4.

    METHODS:Clinical data and data from magnetic resonance imaging (MRI) scans and electroencephalography (EEG) during the acute phase of the disease and during follow-up at 3 and 6 months were analyzed in 50 patients. Twenty-five of these patients underwent neuropsychological testing (WISC IV) during follow-up.

    RESULTS:Neurological involvement (stupor or coma, seizures, visual disturbances, paresis, myocloni) was initially observed in 14/50 (28 %) patients. One patient died. EEG abnormalities were more frequent in patients with neurological involvement than in those without (12/14 vs. 13/25, respectively). Cranial MRI scans were analyzed in nine patients with neurological involvement, of whom five showed abnormal findings. At the 3- and 6-month follow-ups, EEG abnormalities were found in 14/40 (35 %) and 7/36 (19 %) patients, respectively, whereas 28/42 (67 %) and 17/39 (44 %) patients, respectively, complained about on-going reduced performance. Neuropsychological testing showed a slightly lower global intelligence quotient in patients with neurological involvement versus those without (113.4?±?2.8 vs. 119.4?±?1.8, respectively).

    CONCLUSIONS: Neurological involvement was frequent in our cohort. Accordingly, the incidence of pathological EEG findings was high, even in patients without clinical signs of neurological involvement. Nevertheless, major neurological sequelae were rare, and neuropsychological outcome was favorable after 6 months。

    溶血尿毒综合征（HUS）可累及全身多系统，肾脏为最常见受累器官；肾外最常见为中枢神经系统，同时与预后差相关。既往报道儿童D+HUS中枢神经系统受累比例约20%。

    本文总结分析了2011年在德国爆发的E.coli O104:H4感染引起的50例儿童D+HUS中枢神经系统受累情况及预后。中枢神经系统受累比例为14/50（28%），1例死亡。脑电图异常比例在有中枢神经系统受累组高（12/14 vs 13/25）。9/14例接受头颅MRI检查，5/9存在异常。神经心理测试显示有中枢神经系统受累组IQ稍低（113.4±2.8 vs 119.4±1.8）。

    结论：此研究中中枢神经系统受累比例稍高；脑电图异常比例高，包括无神经系统受累临床表现的患者中；严重神经系统病变罕见；随访6个月时，神经心理预后相对较好。

    http://www.ncbi.nlm.nih.gov/pubmed/24664191