Acute post-streptococcal glomerulonephritis in children of French Polynesia: a 3-year retrospective study
Acute post-streptococcal glomerulonephritis in children of French Polynesia: a 3-year retrospective study
复制标题
DOI：
10.1007/s00467-009-1325-4
复制
发表时间：
2010-02-01
影响因子：
3
通讯作者：
Pietrement, Christine
中科院分区：
文献类型：
--
作者：
Becquet, Odile;Pasche, Jerome;Pietrement, Christine
本研究的目的是明确法属波利尼西亚急性链球菌后肾小球肾炎(APSGN)的人口学、临床和预后特征，并将这些特征与其他人群的特征进行比较。50名儿童，均为15岁，在2005年1月至2007年12月期间住进帕皮特地区医院的APSGN，他们被回顾地登记在这项研究中。诊断标准是镜检或肉眼血尿、补体C3成分减少以及最近链球菌感染的证据。2007年，年发病率为每10万名15岁儿童中有18例。大多数参加研究的儿童(98%)是波利尼西亚民族血统，27名男性(54%)，平均发病年龄为6.7岁。40%的儿童有明显的呼吸道感染迹象。大多数患者出现在雨季，与此时皮肤感染的发病率相对较高有关。大多数患者有蛋白尿(98%)，其中25%的患者蛋白尿在肾病范围内(蛋白尿/尿肌酐/GT；3g/g)。22%的儿童表现严重(充血性心力衰竭、严重高血压和/或脑病)，43.7%的儿童以肾功能衰竭为首发症状。C3分数在病情严重时较低，但血尿类型、蛋白尿水平和炎症综合征与即刻严重形式或初始肾功能衰竭无关。血尿消失时间平均为7.7个月，蛋白尿消失时间平均为3.9个月。所有儿童的低补体血症均未超过8周。急性链球菌后肾小球肾炎在法属波利尼西亚人中流行，他们可以被认为是高危人群。尽管皮肤感染的发病率很高，但呼吸道感染的优势潜在地表明，法属波利尼西亚正在成为一个低发病率地区。加强对A组链球菌的系统检测和治疗。
The aim of this study was to define the current demographic, clinical and prognostic characteristics of acute post-streptococcal glomerulonephritis (APSGN) in French Polynesia and to compare these features with those of other populations. Fifty children, all of whom were < 15 years old and had been admitted to the Territorial Hospital of Papeete for APSGN between January 2005 and December 2007, were retrospectively enrolled in the study. Diagnostic criteria were microscopic or macroscopic haematuria, decreased C3 fraction of the complement and evidence of recent streptococcal infection. The annual incidence was 18 cases per 100,000 children < 15 years of age in 2007. Most of the children (98%) enrolled in the study were of Polynesian ethnic origin, 27 were male (54%), and the average age at presentation was 6.7 years. Signs of previous respiratory infections were clearly evident in 40% of the children. Most of the patients presented during the rainy season, correlating with the relatively high incidence of skin infections at this time. The majority of patients had proteinuria (98%), with 25% having proteinuria in the nephrotic range (proteinuria/urinary creatinine > 3 g/g). The presentation was severe in 22% of the children (congestive cardiac failure, severe hypertension and/or encephalopathy), and renal failure was an initial presenting symptom in 43.7%. The C3 fraction was lower in severe presentations, but the type of haematuria, level of proteinuria and inflammatory syndrome were not correlated with immediate severe forms or with initial renal failure. Haematuria resolved in a mean of 7.7 months and proteinuria in a mean of 3.9 months. None of the children had hypocomplementemia for more than 8 weeks. Acute post-streptococcal glomerulonephritis is endemic among French Polynesians, and they can be considered to be a high-risk population. Despite a high incidence of skin infections, however, the predominance of respiratory infections potentially indicates that French Polynesia is on the way to become a low-incidence area. Systematic detection and treatment of group A Streptococcus should be intensified.