TransVIHMI, Université de Montpellier, INSERM Unité 1175, Institut de Recherche pour le Développement, Montpellier, France.
TransVIHMI, Université de Montpellier, INSERM Unité 1175, Institut de Recherche pour le Développement, Montpellier, France; Programme National de Lutte contre l'Onchocercose, Direction de l'Épidémiologie et de la Lutte contre la Maladie, Ministère de la Santé et de la Population, Brazzaville, Republic of the Congo.
Lancet Microbe. 2023 Sep;4(9):e704-e710. doi: 10.1016/S2666-5247(23)00142-8. Epub 2023 Jul 19.
Case reports have hypothesised that proteinuria, sometimes with glomerulopathy or nephrotic syndromes, might be associated with loiasis. To our knowledge, no study has been done to assess this association. We aimed to investigate the association between Loa loa microfilariae burden and proteinuria.
We did a cross-sectional study between May 16, 2022, and June 11, 2022, to assess the relationship between Loa loa microfilaraemia densities and proteinuria in a rural area of the Republic of Congo. We included all consenting adults living in the target area at study commencement who had L loa microfilarial densities greater than 500 microfilariae per mL during previous screening for a clinical trial in 2019. This study is part of the MorLo project, and used the project's study population of individuals aged 18 years or older who were living near Sibiti. For each microfilaraemic individual, two individuals without L loa microfilarial densities matched on age, sex, and place of residence were included. The association between proteinuria (assessed by dipstick) and L loa microfilarial densities, age, and sex was assessed using an unconstrained ordinal regression model since the parallel-lines assumption was violated for microfilarial densities.
991 participants were included, of whom 342 (35%) were L loa microfilaraemic. The prevalence of microfilaraemia was 38% (122 of 325) among individuals with trace proteinuria (<300 mg/24 h), 51% (45 of 89) among individuals with light proteinuria (300 mg to 1 g/24 h), and 71% (15 of 21) among individuals with high proteinuria (>1 g/24 h). Individuals with high proteinuria had significantly higher L loa microfilarial densities (p<0·0001): mean microfilariae per mL were 1595 (SD 4960) among individuals with no proteinuria, 2691 (7982) for those with trace proteinuria, 3833 (9878) for those with light proteinuria, and 13 541 (20 118) for those with high proteinuria. Individuals with 5000-14 999 microfilariae per mL and individuals with 15 000 microfilariae per mL or greater were, respectively, 5·39 and 20·49 times more likely to have a high proteinuria than individuals with no microfilaraemia.
The risk of proteinuria increases with L loa microfilaraemia. Further studies are needed to identify renal disorders (eg, tubulopathies, glomerulopathies, or nephrotic syndromes) responsible for loiasis-related proteinuria.
European Research Council, MorLo project.
For the French translation of the abstract see Supplementary Materials section.
病例报告假设，蛋白尿，有时伴有肾小球病或肾病综合征，可能与旋毛虫病有关。据我们所知，尚未有研究评估这种关联。我们旨在研究罗阿罗阿微丝蚴负担与蛋白尿之间的关系。
我们于 2022 年 5 月 16 日至 6 月 11 日进行了一项横断面研究，以评估刚果共和国农村地区罗阿罗阿微丝蚴密度与蛋白尿之间的关系。我们纳入了所有在研究开始时居住在目标地区、在 2019 年临床试验前筛查中微丝蚴密度大于 500 条/毫升的同意的成年居民。这项研究是 MorLo 项目的一部分，使用了项目的研究人群，即年龄在 18 岁或以上、居住在 Sibiti 附近的个体。对于每一个微丝蚴血症者，我们纳入了两个在年龄、性别和居住地方面与他们相匹配的、无罗阿罗阿微丝蚴密度的个体。使用无约束的有序回归模型评估蛋白尿（通过尿试纸评估）与罗阿罗阿微丝蚴密度、年龄和性别之间的关系，因为微丝蚴密度违反了平行线假设。
共纳入 991 名参与者，其中 342 名（35%）为罗阿罗阿微丝蚴血症者。微丝蚴血症的患病率为 38%（122/325），见于微量蛋白尿（<300 毫克/24 小时）者；51%（45/89）见于轻度蛋白尿（300 毫克至 1 克/24 小时）者；71%（15/21）见于高度蛋白尿（>1 克/24 小时）者。高度蛋白尿者的罗阿罗阿微丝蚴密度明显更高（p<0·0001）：无蛋白尿者的平均微丝蚴数为 1595（SD 4960）/毫升，微量蛋白尿者为 2691（7982）/毫升，轻度蛋白尿者为 3833（9878）/毫升，高度蛋白尿者为 13541（20118）/毫升。有 5000-14999 条/毫升微丝蚴和有 15000 条/毫升或更多微丝蚴的个体，发生高度蛋白尿的风险分别是无微丝蚴血症个体的 5.39 倍和 20.49 倍。
蛋白尿的风险随罗阿罗阿微丝蚴血症而增加。需要进一步的研究来确定导致旋毛虫病相关蛋白尿的肾脏疾病（例如，肾小管病、肾小球病或肾病综合征）。
欧洲研究理事会，MorLo 项目。
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