Reye's syndrome in the United States from 1981 through 1997
Reye's syndrome in the United States from 1981 through 1997
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DOI：
10.1056/nejm199905063401801
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发表时间：
1999-05-06
影响因子：
158.5
通讯作者：
Schonberger, LB
中科院分区：
文献类型：
--
作者：
Belay, ED;Bresee, JS;Schonberger, LB
背景：雷氏综合征以脑病和肝脏脂肪变性为特征，通常发生在流感或水痘之后。从1980年开始，由于雷氏综合症的风险，对患有这些病毒感染的儿童使用水杨酸盐发出了警告。方法分析1980年12月至1997年11月收集的全国监测数据，以描述美国雷氏综合征的模式、患者特征和不良预后的危险因素。监测系统以自愿报告为基础，使用标准病例报告表格。结果1980年12月至1997年11月（1981年至1997年监测年）共报告18岁以下Reye综合征1207例。在可获得种族和性别数据的人中，93%是白人，52%是女孩。雷氏综合征与阿司匹林的关联被报道后，雷氏综合征的报告病例数量急剧下降。1980年报告的儿童病例达到555例的高峰后，自1987年以来每年的病例不超过36例。93%的儿童报告了先前的疾病，82%的儿童血液中可检测到水杨酸水平。总体病死率为31%。病死率最高的是5岁以下儿童（相对危险度，1.8；95%可信区间，1.5至2.1）和血清氨水平高于45 μ g /分升（26 μ mol /升）的儿童（相对危险度，3.4；95%可信区间，1.9至6.2）。自1980年首次报道雷氏综合征与水痘或流感样疾病期间使用阿司匹林之间的关联以来，报告患有雷氏综合征的婴儿和儿童数量急剧下降。由于雷氏综合征现在非常罕见，任何怀疑患有这种疾病的婴儿或儿童都应该进行广泛的调查，以排除可治疗的先天性代谢紊乱，这种紊乱可以模仿雷氏综合征。[J] .中华医学杂志1999；34(3):377- 382。(C) 1999年，马萨诸塞州医学协会。
Background Reye's syndrome is characterized by encephalopathy and fatty degeneration of the liver, usually after influenza or varicella. Beginning in 1980, warnings were issued about the use of salicylates in children with those viral infections because of the risk of Reye's syndrome.Methods To describe the pattern of Reye's syndrome in the United States, characteristics of the patients, and risk factors for poor outcomes, we analyzed national surveillance data collected from December 1980 through November 1997. The surveillance system is based on voluntary reporting with the use of a standard case-report form.Results From December 1980 through November 1997 (surveillance years 1981 through 1997), 1207 cases of Reye's syndrome were reported in patients less than 18 years of age. Among those for whom data on race and sex were available, 93 percent were white and 52 percent were girls. The number of reported cases of Reye's syndrome declined sharply after the association of Reye's syndrome with aspirin was reported. After a peak of 555 cases in children reported in 1980, there have been no more than 36 cases per year since 1987. Antecedent illnesses were reported in 93 percent of the children, and detectable blood salicylate levels in 82 percent. The overall case fatality rate was 31 percent. The case fatality rate was highest in children under five years of age (relative risk, 1.8; 95 percent confidence interval, 1.5 to 2.1) and in those with a serum ammonia level above 45 mu g per deciliter (26 mu mol per liter) (relative risk, 3.4; 95 percent confidence interval, 1.9 to 6.2).Conclusions Since 1980, when the association between Reye's syndrome and the use of aspirin during varicella or influenza-like illness was first reported, there has been a sharp decline in the number of infants and children reported to have Reye's syndrome. Because Reye's syndrome is now very rare, any infant or child suspected of having this disorder should undergo extensive investigation to rule out the treatable inborn metabolic disorders that can mimic Reye's syndrome. (N Engl J Med 1999;340:1377-82.) (C) 1999, Massachusetts Medical Society.