Goodfellow A M, Hoy W E, Sriprakash K S, Daly M J, Reeve M P, Mathews J D
Menzies School of Health Research, Casuarina NT, Australia.
Epidemiol Infect. 1999 Feb;122(1):67-75. doi: 10.1017/s0950268898001812.
Aboriginal communities in Northern Australia with high rates of group A streptococcal (GAS) skin infection in childhood also have high rates of renal failure in adult life. In a cross-sectional study of one such high risk community, albuminuria was used as a marker of renal disease. The prevalence of albuminuria increased from 0/52 in subjects aged 10-19 years to 10/29 (32.9%) in those aged 50 or more (P < 0.001). Antibodies to streptococcal M protein, markers of past GAS infection, were present in 48/52 (92%) at ages 10-19 years, 16/32 (50%) at ages 30-39, and 20/29 (69%) in those aged 50 or more. After allowing for the age-dependencies of albuminuria and of M protein antibodies (P < 0.001) albuminuria was significantly associated with M protein antibodies (P < 0.01). Thus, 72% of adults aged 30 or more with M protein antibodies also had albuminuria, compared with only 21% of those who were seronegative. More detailed modelling suggested that although most Aboriginal people in this community developed M protein antibodies following GAS infection in childhood, the development of proteinuria was associated with the persistence of such seropositivity into adult life. The models predicted that proteinuria developed at a mean age of 30 years in seropositive persons, at 45 years in seronegative persons who were overweight, and at 62 years in seronegative persons of normal weight. We demonstrated a clear association between evidence of childhood GAS infection and individual risk of proteinuria in adult life. This study provided a strong rationale for prevention of renal disease through the more effective control of GAS skin infections in childhood and through the prevention of obesity in adult life.
澳大利亚北部原住民社区儿童A组链球菌（GAS）皮肤感染率高，成年后患肾衰竭的比例也高。在对一个此类高危社区的横断面研究中，蛋白尿被用作肾病标志物。蛋白尿患病率从10 - 19岁人群中的0/52升至50岁及以上人群中的10/29（32.9%）（P < 0.001）。抗链球菌M蛋白抗体是既往GAS感染的标志物，在10 - 19岁人群中48/52（92%）呈阳性，30 - 39岁人群中16/32（50%）呈阳性，50岁及以上人群中20/29（69%）呈阳性。在考虑蛋白尿和M蛋白抗体的年龄依赖性后（P < 0.001），蛋白尿与M蛋白抗体显著相关（P < 0.01）。因此，30岁及以上有M蛋白抗体的成年人中72%也有蛋白尿，而血清阴性者中只有21%有蛋白尿。更详细的模型分析表明，虽然该社区大多数原住民儿童期感染GAS后会产生M蛋白抗体，但蛋白尿的发生与这种血清阳性状态持续至成年有关。模型预测，血清阳性者蛋白尿发病的平均年龄为30岁，超重的血清阴性者为45岁，体重正常的血清阴性者为62岁。我们证明了儿童期GAS感染证据与成年期蛋白尿个体风险之间存在明确关联。本研究为通过更有效控制儿童期GAS皮肤感染以及预防成年期肥胖来预防肾病提供了有力依据。
