乙型肝炎病毒相关性肾炎的临床与病理分析

目的探讨乙型肝炎病毒（HBV）相关性肾炎临床病理特点。方法分析17例HBV相关性肾炎的临床表现及肾活检病理、免疫荧光和超微病理特点。结果17例HBV相关性肾炎临床表现以肾病综合征最常见10例（58.82%）,肾炎综合征7例（41.18%）。病理类型多样化,其中膜性肾病（MN）8例（47.06%）,系膜增生性肾炎（MsPGN）7例（41.18%）,系膜毛细血管性肾炎（MPGN）1例（5.88%）,IgA肾病（IgAN）1例（5.88%）。免疫荧光检查5.88%的病例呈＂满堂亮＂现象;电镜观察HBV相关性膜性肾病易见电子致密物系膜沉积。结论HBV-GN的病理类型以HBV-MN为主,多见于中青年人,肾组织HBVAg免疫组化标志为诊断HBV-GN的重要指标。鉴于HBV相关性肾炎的一些病理特点与狼疮性肾炎相似,有必要结合临床对二者进行鉴别。

Association of Pathology and clinical analysis of hepatitis B virus-associated glomerulonephritis

Objective To investigate the clinicopathologic features of hepatitis B virus-associated glomerulonephritis（HBV-GN）.Methods 17 cases with HBV-GN were confirmed by renal biopsy.Clinicopathologic characters of these cases were analyzed with immunofluorescence and electron microscope.Results The clinicopathologic manifestation of HBV-GN was various.Nephrotic syndrome was the mostly encountered clinical manifestation,with the rate of 58.82%.The second were nephritic syndrome,with the respective rate of 41.18%.The most common pathological types of HBV-GN were membranous nephropathy,with the rate of 47.06%.The second were non IgA-mesangial proliferative glomerulonephritis and mesangiocapillaryglomerulonephritis,with the rate of 41.18% and 5.88% respectively,IgA nephropathy,with the rate of 5.88%.By immunofluorescence microscope,5.88% of the total cases displayed ＂full house＂ phenomenon.By electron microscope（EM）,hepatitis B virus-associated membranous nephropathy（HBV-MN） was easy found with mesangial dense deposits.Conclusion Main pathological of HBV-GN is HBV-MN,HBV-MN is more common in young people.Immunohistochemical makers of HBV antigen are important criteria for diagnosis of HBV-GN.The pathologic features of HBV-GN were sometimes similar to that of Systemic Lupus Erythematosus nephritis.It is necessary that HBV-GN be differenced from Systemic Lupus Erythematosus nephritis by clinic.