Dossier Claire, Sellier-Leclerc Anne-Laure, Rousseau Alexandra, Michel Yanne, Gautheret-Dejean Agnès, Englender Mariana, Madhi Fouad, Charbit Marina, Ulinski Tim, Simon Tabassome, Jacqz-Aigrain Evelyne, Deschênes Georges
Service de Néphrologie Pédiatrique, Hôpital Robert Debré, 48Bd Serurier, Paris, 75935 Cedex 19, France.
Pediatr Nephrol. 2014 Dec;29(12):2325-31. doi: 10.1007/s00467-014-2860-1. Epub 2014 Jun 5.
Idiopathic nephrotic syndrome (INS) is likely a primary immune disorder, but viruses might also be involved in the mechanisms of the disease. Here, we investigate the link between herpesvirus infection and the first manifestation of INS in children.
A prospective, multicentre, and population-based case-control study called NEPHROVIR included 164 patients, aged 6 months to 15 years old, newly diagnosed with INS, and 233 controls matched for gender, age, and period of sample. The analysis was done on 124 patients and 196 controls. Epstein-Barr virus (EBV), cytomegalovirus (CMV), human herpesvirus-6 (HHV-6), and human herpesvirus-7 (HHV-7) DNA prevalence at diagnosis were assessed from whole peripheral blood samples, as well as EBV and CMV viral load and seroprevalence.
EBV DNA was significantly more prevalent in cases than in controls (50.8 vs 29.1 %; OR = 2.6; p = 0.0002), with no difference in viral load. A significant difference was also found for CMV (11.3 vs 3.6 %; p = 0.02) and HHV-7 (83 vs 72 %; p = 0.02) DNA prevalence between cases and controls. There were significantly more EBV and CMV recent infections or reactivations based on VCA-IgM and CMV IgM in cases than controls, while there were no differences in IgG seroprevalence.
The prevalence of positive EBV DNA detection and recent infection or reactivation is higher in children at onset of INS compared to a population matched for age, gender, and time of sampling.
特发性肾病综合征（INS）可能是一种原发性免疫疾病，但病毒也可能参与该疾病的发病机制。在此，我们研究疱疹病毒感染与儿童INS首发表现之间的联系。
一项名为NEPHROVIR的前瞻性、多中心、基于人群的病例对照研究纳入了164例年龄在6个月至15岁之间新诊断为INS的患者，以及233例在性别、年龄和采样时间方面相匹配的对照。对124例患者和196例对照进行了分析。从全外周血样本中评估诊断时爱泼斯坦-巴尔病毒（EBV）、巨细胞病毒（CMV）、人类疱疹病毒6型（HHV-6）和人类疱疹病毒7型（HHV-7）DNA的流行率，以及EBV和CMV病毒载量及血清阳性率。
病例组中EBV DNA的流行率显著高于对照组（50.8%对29.1%；比值比=2.6；p=0.0002），病毒载量无差异。病例组和对照组之间CMV（11.3%对3.6%；p=0.02）和HHV-7（83%对72%；p=0.02）DNA流行率也存在显著差异。基于VCA-IgM和CMV IgM，病例组近期EBV和CMV感染或再激活显著多于对照组，而IgG血清阳性率无差异。
与年龄、性别和采样时间相匹配的人群相比，INS发病儿童中EBV DNA检测阳性及近期感染或再激活的发生率更高。
