Dossier Claire, Lapidus Nathanael, Bayer Florian, Sellier-Leclerc Anne-Laure, Boyer Olivia, de Pontual Loic, May Adrien, Nathanson Sylvie, Orzechowski Christine, Simon Tabassome, Carrat Fabrice, Deschênes Georges
Service de Néphrologie Pédiatrique, Hôpital Robert-Debré, APHP, Paris, France.
Sorbonne Universités, UPMC Univ Paris 06, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP UMRS 1136), F75012, Paris, France.
Pediatr Nephrol. 2016 Dec;31(12):2299-2308. doi: 10.1007/s00467-016-3509-z. Epub 2016 Oct 24.
The etiology of idiopathic nephrotic syndrome (INS) remains partially unknown. Viral infections have been reported to be associated with INS onset and relapse. The aim of this study was to describe the epidemiology of a population-based cohort of children with INS and propose a spatiotemporal analysis.
All children aged 6 months to 15 years with INS onset between December 2007 and May 2010 and living in the Paris area were included in a prospective multicenter study. Demographic and clinical features at diagnosis and 2 years were collected.
INS was diagnosed in 188 children, 93 % of whom were steroid sensitive. Annual incidence was 3.35/100,000 children. Standardized incidence ratio (SIR) was higher in one of the eight counties: Seine-Saint-Denis, with SIR 1.43 [95 % confidence interval (CI) 1.02-1.95]. A spatial cluster was further identified with higher SIR 1.36 (95 % CI 1.09-1.67). Temporal analysis within this overincidence area showed seasonal variation, with a peak during the winter period (p <0.01). In addition, partition of the Paris area into quintiles of the population showed that the average delay of occurrence, with regard to the first study case, followed a longitudinal progression (p <0.0001).
The clustering of cases, the seasonal variation within this particular area, and the progression over the Paris area altogether suggest that INS may occur on an epidemic mode.
特发性肾病综合征（INS）的病因仍部分不明。据报道，病毒感染与INS的发病和复发有关。本研究旨在描述一个基于人群的INS儿童队列的流行病学特征，并进行时空分析。
所有在2007年12月至2010年5月期间发病、年龄在6个月至15岁之间且居住在巴黎地区的INS儿童被纳入一项前瞻性多中心研究。收集诊断时和2年时的人口统计学和临床特征。
188名儿童被诊断为INS，其中93%对类固醇敏感。年发病率为3.35/10万儿童。在八个县之一的塞纳-圣但尼，标准化发病率（SIR）较高，为1.43[95%置信区间（CI）1.02-1.95]。进一步确定了一个空间聚集区，SIR更高，为1.36（95%CI 1.09-1.67）。在这个发病率过高的区域内进行时间分析显示出季节性变化，冬季达到高峰（p<0.01）。此外，将巴黎地区按人口五分位数划分显示，相对于第一个研究病例，平均发病延迟呈纵向进展（p<0.0001）。
病例的聚集、该特定区域内的季节性变化以及巴黎地区的进展情况共同表明，INS可能以流行模式发生。
