高尿酸血症在乙型肝炎病毒相关性肾炎中的作用

目的：探讨高尿酸血症在乙型肝炎病毒相关性肾炎（HBV-GN）中的作用。方法：对227例HBV-GN临床病理资料进行病例对照研究,将其分为高尿酸血症组（A组）及血尿酸正常组（B组）,比较两组临床病理资料,分析血尿酸水平与临床病理指标的关系。结果：高尿酸血症组高血压发生率为29.58%（21/71）,明显高于尿酸正常组17.95%（28/156）,P〈0.05。A组eGFR〈60ml/min者发生率达32.39%（23/71）,明显高于B组（9.61%,P〈0.01）。A组血清肌酐和尿素氮水平明显高于B组（P〈0.01）。A组的膜性肾病（MN）发生率低于B组（P〈0.05）,而增生硬化性肾炎（SGN）明显高于B组（P〈0.01）。高尿酸血症组肾小球硬化≥50%、新月体形成、系膜中度增生和肾小管间质中度病变重比例明显高于尿酸正常组（P〈0.05）。MN与系膜增生性肾炎（MsPGN）两个亚组中高尿酸血症患者eGFR〈60ml/min者发生率明显高于其血尿酸正常者（P〈0.05）。结论：高尿酸血症会促进HBV-GN高血压的发生、加重肾小管间质损害,是影响HBV-GN进展的危险因素之一。

The Significance of Hyperuricemia in the Patients with Hepatitis B Virus-associated Glomerulonephritis

Objective：To study the significance of hyperuricemia in the patients with Hepatitis B virus-associated Glomerulonephritis（HBV-GN）.Methods：A retrospective control study was carried out in 227 cases with HBV-GN diagnosed by renal biopsy.The patients were divided into two group：group A（the patients with hyperuricemia,n=71）and group B（with normal serum uric acid,n=156）.The data wasanalyzed and compared between two groups.Results：The incidence of hypertension and lower eGFR（eGFR60 ml/min）in group A was higher than that in group B（hypertension：29.58% vs 17.95%,P0.05,eGFR60 ml/min：32.39% vs 9.61%,P0.01）.The level of serum creatinine and urea nitrogen were higher in group A than those in group B.The percentage of membranous nephropathy（MN）was lower in group A,but the percentage of proliferative slerosic glomeulonephritis was higher in group A.The incidence of serious glomeruli sclerosis（≥50%）,crescents formation,moderate-serious degree mesangial proliferation and renal interstitial tubular demage was higher in group A than those in group B.Meanwhile,among the patients with MN subgroup or mesangial proliferative glomerulonephritis subgroup,the incidence of lower eGFR was higher in the patients with hyperuricemia than the patients without hyperuricemia.Conclusion：Hyperuricemia may facilitate development of hypertension,aggravate renal tubule-interstitial injury and be one of risk factors for progression of HBV-GN.