儿童肾病综合征发病率及预后的种族差异

Ethnic Differences in Incidence and Outcomes of Childhood Nephrotic Syndrome.

作者信息

Banh Tonny H M, Hussain-Shamsy Neesha, Patel Viral, Vasilevska-Ristovska Jovanka, Borges Karlota, Sibbald Cathryn, Lipszyc Deborah, Brooke Josefina, Geary Denis, Langlois Valerie, Reddon Michele, Pearl Rachel, Levin Leo, Piekut Monica, Licht Christoph P B, Radhakrishnan Seetha, Aitken-Menezes Kimberly, Harvey Elizabeth, Hebert Diane, Piscione Tino D, Parekh Rulan S

机构信息

Child Health Evaluative Sciences, Research Institute.

Division of Nephrology, and.

出版信息

Clin J Am Soc Nephrol. 2016 Oct 7;11(10):1760-1768. doi: 10.2215/CJN.00380116. Epub 2016 Jul 21.

DOI:10.2215/CJN.00380116

PMID:27445165

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5053779/

Abstract

BACKGROUND AND OBJECTIVES

Ethnic differences in outcomes among children with nephrotic syndrome are unknown.

DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We conducted a longitudinal study at a single regional pediatric center comparing ethnic differences in incidence from 2001 to 2011 census data and longitudinal outcomes, including relapse rates, time to first relapse, frequently relapsing disease, and use of cyclophosphamide. Among 711 children, 24% were European, 33% were South Asian, 10% were East/Southeast Asian, and 33% were of other origins.

RESULTS

Over 10 years, the overall incidence increased from 1.99/100,000 to 4.71/100,000 among children ages 1-18 years old. In 2011, South Asians had a higher incidence rate ratio of 6.61 (95% confidence interval, 3.16 to 15.1) compared with Europeans. East/Southeast Asians had a similar incidence rate ratio (0.76; 95% confidence interval, 0.13 to 2.94) to Europeans. We determined outcomes in 455 children from the three largest ethnic groups with steroid-sensitive disease over a median of 4 years. South Asian and East/Southeast Asian children had significantly lower odds of frequently relapsing disease at 12 months (South Asian: adjusted odds ratio; 0.55; 95% confidence interval, 0.39 to 0.77; East/Southeast Asian: adjusted odds ratio; 0.42; 95% confidence interval, 0.34 to 0.51), fewer subsequent relapses (South Asian: adjusted odds ratio; 0.64; 95% confidence interval, 0.50 to 0.81; East/Southeast Asian: adjusted odds ratio; 0.47; 95% confidence interval, 0.24 to 0.91), lower risk of a first relapse (South Asian: adjusted hazard ratio, 0.74; 95% confidence interval, 0.67 to 0.83; East/Southeast Asian: adjusted hazard ratio, 0.65; 95% CI, 0.63 to 0.68), and lower use of cyclophosphamide (South Asian: adjusted hazard ratio, 0.82; 95% confidence interval, 0.53 to 1.28; East/Southeast Asian: adjusted hazard ratio, 0.54; 95% confidence interval, 0.41 to 0.71) compared with European children.

CONCLUSIONS

Despite the higher incidence among South Asians, South and East/Southeast Asian children have significantly less complicated clinical outcomes compared with Europeans.

摘要

背景与目的

肾病综合征患儿的预后种族差异尚不明确。

设计、地点、参与者及测量方法：我们在一家地区性儿科中心开展了一项纵向研究，比较了2001年至2011年人口普查数据中的发病率种族差异以及纵向预后情况，包括复发率、首次复发时间、频繁复发性疾病以及环磷酰胺的使用情况。在711名儿童中，24%为欧洲裔，33%为南亚裔，10%为东亚/东南亚裔，33%为其他族裔。

结果

在10年期间，1至18岁儿童的总体发病率从1.99/10万增至4.71/10万。2011年，南亚裔的发病率比欧洲裔高6.61（95%置信区间为3.16至15.1）。东亚/东南亚裔的发病率比与欧洲裔相似（0.76；95%置信区间为0.13至2.94）。我们确定了来自三个最大种族且患有类固醇敏感型疾病的455名儿童的中位4年预后情况。与欧洲儿童相比，南亚和东亚/东南亚儿童在12个月时频繁复发性疾病的几率显著更低（南亚裔：调整后的优势比为0.55；95%置信区间为0.39至0.77；东亚/东南亚裔：调整后的优势比为0.42；95%置信区间为0.34至0.51），后续复发次数更少（南亚裔：调整后的优势比为0.64；95%置信区间为0.50至0.81；东亚/东南亚裔：调整后的优势比为0.47；95%置信区间为0.24至0.91），首次复发风险更低（南亚裔：调整后的风险比为0.74；95%置信区间为0.67至0.83；东亚/东南亚裔：调整后的风险比为0.65；95%置信区间为0.63至0.68），且环磷酰胺的使用量更低（南亚裔：调整后的风险比为0.82；95%置信区间为0.53至1.28；东亚/东南亚裔：调整后的风险比为0.54；95%置信区间为0.41至0.71）。