预防腹相关的血液溶解尿素性尿素综合征的干预措施
Aamer Imdad1, John R Nelson2, Emily E Tanner-Smith3
1Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology, Pancreatology and Nutrition, University of Iowa, Iowa City, IA, USA.
The Cochrane database of systematic reviews
|April 25, 2025
概括
在儿童和成年人患有Siga毒素产生的大肠杆菌 (STEC) 腹时,预防血溶性尿素综合征 (HUS) 仍然不确定. 目前关于抗生素和单克隆抗体等干预措施的证据有限,需要进一步研究有效的二次预防策略.
科学领域:
- 腎病學與傳染病的研究
- 儿科脏病学 儿科脏病学
- 胃肠病学 胃肠病学
背景情况:
- 溶血性尿素性综合征 (HUS) 是儿童获得性功能衰竭的主要原因,通常由滋果毒素产生的大肠杆菌 (STEC) 胃肠道感染引发.
- 本综述更新了先前关于在患有STEC或类似高风险细菌引起的腹的患者中对HUS的二次预防的研究结果.
研究的目的:
- 评估干预措施的好处和危害,用于二次预防HUS在儿科和成人患者腹.
- 将干预措施与安慰剂或标准护理进行比较,以减少HUS发病率和死亡率.
主要方法:
- 在2025年1月之前,对科克兰脏和移植研究注册表进行了系统的搜索.
- 包括的研究是随机对照试验 (RCT) 或准RCT,评估诸如抗生素,抗Shiga毒素抗体,毒素结合剂和水分等干预措施.
- 主要结局是HUS发病率;次要结局包括功能衰竭,需要置换疗法 (KRT),死亡和不良事件.
主要成果:
- 在2025年更新中没有添加任何新研究;结果与2021年审查保持一致.
- 抗生素 (trimethoprim-sulfamethoxazole),牛乳粉,Siga毒素结合剂 (Synsorb Pk) 和单克隆抗体 (urtoxazumab) 预防HUS的有效性证据的确定性非常低.
- 没有足够的数据来得出关于这些干预措施的好处或危害的确切结论,对关键次要结果 (如KRT和死亡) 的报道有限.
结论:
- 目前针对STEC感染个体的二次HUS预防的干预措施缺乏有效性或安全性的强有力的证据.
- 样本规模小,研究数量有限,因此无法得出明确的结论.
- 较大的多中心研究对于确定高风险腹疾病后预防HUS的有效策略至关重要.
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