HBV-GN肾小管间质损害的发生影响因素及临床意义

目的:探讨乙肝相关性肾炎(HBV-GN)中肾小管间质损害(TIL)的发生情况、影响因素及临床意义。方法:单因素及多因素分析227例HBV-GN患者TIL发生的影响因素,比较不同程度TIL患者的临床病理资料。结果:肾小管间质损害轻度者占59.5%,中度者占17.6%,重度者占4.8%,无肾小管间质损害者仅占18.1%。不同病理类型HBV-GN患者其TIL发生率各不相同,年龄>14岁、高血压、尿蛋白≥0.3g/d、血肌酐≥132.6μmol/L、球囊黏连、新月体形成、系膜增殖程度和肾小球硬化率是TIL发生的危险因素,其中高血压、系膜增殖程度和肾小球硬化率是TIL发生的独立影响因素;随着肾小管间质损害的发生或加重,尿蛋白≥0.3g/d、高血压、高尿酸血症、肾功能异常和上述4种肾小球病理改变的发生率亦增高。结论:肾小管间质损害在HBV-GN患者的十分常见,高血压、系膜增殖程度和肾小球硬化率是TIL的独立危险因素,TIL发生或加重对其肾小球病理改变也有明显影响,是影响HBV-GN预后的不良因素之一。

The Influencing Factors of the Incidence of Tubulointerstitial Lesions in Hepatitis B virus-associated Glomerulonephritis and Clinical Significance of Tubulointerstitial Lesions

Objective：To study the influencing factor of the incidence tubulointerstitial lesions（TIL）in the patients with hepatitis B virus associated glomerulonephritis（HBV-GN）and clinical significance of TIL.Methods：A retrospective control study was carried out in 227 cases with HBV-GN diagnosed by renal biopsy.Univariate analysis and multivariate logistic regression analysis were performed to identify the risk for TIL.Comparison was taken among the different degrees of TIL to find out the association between tubulointerstitial lesions and clinic-pathological factors.Results：The incidence of TIL in HBV-GN was 81.9%（186/227）.The incidence of TIL was significantly difference among different pathologic type in HBV-GN.Single-variable analysis showed that age（14）,albuminuria（≥0.3 g/d）,hypertension,level of serum creatinine（≥132.6 μmol/L）,saccule adhesion,mesangial proliferation,glomerular sclerosis and crescent formation were correlated to TIL.Multivariate logistic regression analysis showed that the independent factors for TIL included hypertension,mesangial proliferation and glomerular sclerosis.Moreover,the incidence of albuminuria,hypertension,hyperuricemia,renal function and the four pathological changes mentioned above were correlated with the degree of TIL.Conclusion：TIL is very common in the patients with HBV-GN.hypertension,mesangial proliferation and glomerular sclerosis are the independent factors for TIL.Whereas severity of TIL is probably decisive in pathological changes on glomeruli.TIL is one of the adverse factors for the prognosis with HBV-GN.