Hallett A F, Adhikari M, Cooper R, Coovadia H M
Trans R Soc Trop Med Hyg. 1977;71(3):241-6. doi: 10.1016/0035-9203(77)90016-5.
Streptococcal infection remains almost the sole cause of the clinical syndrome of acute glomerulonephritis in African children. Evidence for this is in elevated levels of antistreptolysin "O" (ASO) titre in 93% of 28 patients and growth of Group Abeta haemolytic streptococci from the skin and throat in 32%. Spread of infection from the skin, where lesions were present in all patients, to the throat would account for positive cultures at both sites and the frequent and vigorous antistreptolysin "O" responses. Clinical recovery occurred in most within seven days and in all within 60 days of admission. IgG and IgA, but not IgM, were increased in patients; C4 was normal in the majority and low in seven out of 24 (29%), C3 was diminished in 26 out of 28 (93%) and the mean level of C3 PA was lower than in controls. Total haemolytic complement paralleled C3 values; C3 breakdown products were not detected in any patient. Renal biopsies in seven out of 28 patients showed typical histological changes of diffuse exudative proliferative glomerulonephritis on light microscopy and fibrinogen and C3 on immunofluorescent staining. These findings suggest that events leading to glomerular damage in acute post-streptococcal nephritis in African children involve activation of both classical and alternative pathways of complement proteins and also confirm the well recognized and predictable nature of the disease, irrespective of geographical distribution.
链球菌感染几乎仍是非洲儿童急性肾小球肾炎临床综合征的唯一病因。28例患者中有93%的抗链球菌溶血素“O”（ASO）滴度升高，32%的患者皮肤和咽喉部培养出Aβ溶血性链球菌，这些均为此提供了证据。所有患者均有皮肤病变，感染从皮肤扩散至咽喉部，这可以解释两个部位培养结果呈阳性以及频繁且强烈的抗链球菌溶血素“O”反应。大多数患者在入院7天内临床症状缓解，所有患者在60天内均康复。患者体内IgG和IgA升高，但IgM未升高；多数患者C4正常，24例中有7例（29%）降低，28例中有26例（93%）C3减少，C3PA平均水平低于对照组。总溶血补体与C3值平行；所有患者均未检测到C3裂解产物。28例患者中有7例行肾活检，光镜下显示典型的弥漫性渗出性增殖性肾小球肾炎组织学改变，免疫荧光染色显示有纤维蛋白原和C3。这些发现表明，非洲儿童急性链球菌感染后肾炎导致肾小球损伤的过程涉及补体蛋白经典途径和替代途径的激活，也证实了该疾病具有公认的、可预测的特性，与地理分布无关。
