乙型肝炎病毒相关性肾炎的诊治——附20例报告

目的总结乙型肝炎病毒相关性肾炎（HBV-GN）患者的临床及病理特点,以提高HBV-GN的诊治水平。方法经肾活检确诊为HBV-GN的患者20例,回顾性分析患者临床表现、实验室检查（尿常规、24h尿蛋白定量、转氨酶、血清清蛋白、HBV-DNA等）、肾组织光镜改变及免疫荧光（IgG、IgA、IgM、C3、C1q、FRA、HBsAg、HBcAg、HBeAg）染色结果,并分析其临床及病理特点。结果本组20例,其中肾病综合征10例,肾炎综合征9例,无症状镜下血尿1例。病理分型以非典型膜性肾病最多见（MN）,共16例（占78％）,系膜增生性肾小球肾炎（MsPGN）2例（占10％）,系膜毛细血管性肾炎（MPGN）2例（占10％）。7例患者HBV-DNA阴性。给予抗病毒联合激素治疗后,大多数患者肾功能稳定。结论目前HBV-GN的确诊仍依赖肾活检,在乙型肝炎高发区应常规进行肾活检组织乙型肝炎病毒标志物检测。

Diagnosis and treatment of hepatitis B virus associated glomerulonephritis in 20 patients

Objective To improve the diagnosis and treatment of hepatitis B virus associated glomerulonephritis（HBV-GN） by analyzing the clinical and pathological features of 20 patients. Method Clinicopathological features of 20 patients with HBV-GN diagnosed by renal biopsy were analyzed retrospectively. The ctinical manifestation and laboratory examination data （ routine urianlysis, 24 hour urinary protein excretion, the marker of HBV infection, transaminase, serum albumn, HBV-DNA, et al）. The pathological features of renal tissue were analyzed under the lightmicroscope and by immunofluorescence methods. Result Nephrotic syndrome（NS）was the prominent clinical type（50%）, followed by hematuria with proteinuria（45 % ）and hematuria without proteinuria（5 % ）. The most common pathological type of HBV-GN was atypical membranous nephropathy （MN） （ 78%）, then mesangial proliferative glomerulonephritis （ MsPGN ） （ 10 %） and membranop proliferative glomerulonephritis （MPGN） （10%）. HBV-DNA were negative in 7 patients. The renal function retained stable in most patients after combination therapy of antivirus and corticoids. Conclusion The diagnosis of HBV-GN still depended renal biopsy. In higher prevalence area of HBV, detecting the marker of HBV infection in renal tissue should be part of renal pathology examination.