PDF(Pubmed)
Abstract：
Background: Shiga toxin-producing Escherichia coli-haemolytic uremic syndrome (STEC-HUS) can result in kidney and neurological complications. Early volume-expansion therapy has been shown to improve outcomes, but caution is required to avoid fluid overload. Lung ultrasound scanning (LUS) can be used to detect fluid overload and may be useful in monitoring hydration therapy. Methods: This prospective observational pilot study involved children with STEC-HUS who were recruited from a regional paediatric nephrology centre. B-line quantification by LUS was used to assess fluid status at the emergency department (ED) admission and correlated with the decrease in patient weight from the target weight. A control group of children on chronic dialysis therapy with episodes of symptomatic fluid overload was also enrolled in order to establish a B-line threshold indicative of severe lung congestion. Another cohort of \"healthy\" children, without renal or lung-related diseases, and without clinical signs of fluid overload was also enrolled in order to establish a B-line threshold indicative of euvolemia. Results: LUS assessment was performed in 10 children with STEC-HUS at ED admission, showing an average of three B-lines (range 0-10). LUS was also performed in 53 euvolemic children admitted to the ED not showing kidney and lung disease (healthy controls), showing a median value of two B-lines (range 0-7), not significantly different from children with STEC-HUS at admission (p = 0.92). Children with STEC-HUS with neurological involvement during the acute phase and those requiring dialysis presented a significantly lower number of B-lines at admission compared to patients with a good clinical course (p < 0.001). Patients with long-term renal impairment also presented a lower number of B-lines at disease onset (p = 0.03). Conclusions: LUS is a useful technique for monitoring intravenous hydration therapy in paediatric patients with STEC-HUS. A low number of B-lines at ED admission (<5 B-lines) was associated with worse short-term and long-term outcomes. Further studies are needed to determine the efficacy and safety of an LUS-guided strategy for reducing complications in children with STEC-HUS.
摘要：
背景：产志贺毒素的大肠杆菌溶血性尿毒综合征（STEC-HUS）可导致肾脏和神经系统并发症。早期容量扩张疗法已被证明可以改善预后，但要小心避免流体过载。肺部超声扫描（LUS）可用于检测液体超负荷，并可用于监测水合治疗。方法：这项前瞻性观察性试点研究涉及从地区儿科肾脏病中心招募的STEC-HUS儿童。通过LUS进行的B线定量用于评估急诊科（ED）入院时的液体状态，并与患者体重从目标体重的减少相关。还招募了一个接受慢性透析治疗并有症状性液体超负荷发作的儿童对照组，以建立指示严重肺充血的B线阈值。另一组“健康”儿童，没有肾脏或肺部相关疾病，并且没有液体超负荷的临床症状也被纳入,以建立指示血容量正常的B线阈值.结果：10例STEC-HUS患儿入院时进行LUS评估，显示三个B线的平均值（范围0-10）。LUS还对53名接受ED的未显示肾脏和肺部疾病的患者进行了检查（健康对照），显示两条B线的中值(范围0-7)，入院时与STEC-HUS患儿无显著差异(p=0.92)。与临床病程良好的患者相比，急性期有神经系统受累的STEC-HUS患儿和需要透析的患儿在入院时的B线数量明显减少（p<0.001）。患有长期肾功能损害的患者在疾病发作时也呈现较低数量的B线(p=0.03)。结论：LUS是监测STEC-HUS儿科患者静脉水化治疗的有用技术。ED入院时B线数量少（<5条B线）与短期和长期结果较差相关。需要进一步的研究来确定LUS指导策略减少STEC-HUS患儿并发症的有效性和安全性。
