乙型肝炎病毒相关性肾炎13例临床与病理分析

目的：探讨乙型肝炎病毒相关性肾炎的临床与病理特点。方法：经临床病理活检确诊的乙型肝炎病毒相关性肾炎患者13例，根据乙型肝炎免疫组织化学染色结果分为两组：Ⅰ组(HBsAg阳性组)：7例；Ⅱ组(HBsAg HBcAb阳性组)：6例。并对两组的临床诊断、病理类型及免疫荧光的情况进行分析。结果：①临床诊断：Ⅰ组：肾病综合征4例(占57．14％)．慢性肾炎2例(占28．57％)，急性肾炎1例(占14．29％)；Ⅱ组：肾病综合征(占83．33％)．慢性肾炎1例(占16．67％)；②病理类型：I组：膜性肾病2例(占28．57％)．系膜增生2例(占28．57％)．弥漫硬化1例(占14．29％)，膜增殖2例(占28．57％)；Ⅱ组：膜性肾病3例(占50％)，系膜增生1例(占16．67％)，弥漫硬化2例(占33．33％)；③免疫荧光：免疫球蛋白沉积以IgA IgG IgM为主．其中Ⅱ组5例(占71．43％)，Ⅱ组5例(占83．33％)，补体C3沉积Ⅰ组6例(占85．71％)，Ⅱ组6例(占100％)。结论：乙型肝炎病毒相关性肾炎，临床表现多样化．病理轻重不一，易误诊，应肾活检。

Clinic and Pathologic Characteristics of HBV-Associated Nephritis

Objective:To study clinic and pathologic features of 13 cases of HBV-associated nephritis.Methods:According to the result of immunobistochemistry in renal histocyte of 13 cases of HBV-associated nephritis,the patients were divided into HBsAg group(group I)and HBsAg and HBcAb group(group II);and their clinical diagnosis,pathologic type and immunohistofluorescence were analyzed.Results:1.The clinical: In group I there were 4 cases were diagnosed with nephropathy syndrome(57.14%),2 cases with chronic golmerulonephritis(28.57%),I case with acute glomerulonephritis(14.29%).While in group II there were 5 cases were diagnosed with nephropathy syndrome (83.33%) and 1 case with chronic glomerulonephtitis(16.67%);2.Pathologic types:2 cases of group I were diagnosed with membranous nephropathy type(28.57%),2 cases with mesangialproliferative glomerulonephritis types(28.57%),1 case with diffuse sclerosing glomerulonephritis(14.29%),and 2 cases with membranoprolirerative glomerulonephritis type(28.57%).3.cases of II group were diagnosed membranous nephropathy type(50%).1 case of II group was diagnosed mesangical proliferative glomerulonephritis type(16.67%).2 cases of II group were diagnosed diffuse sclerosing glomerulonephritis(33.33%);3.Immunohistofluorescence:there were 5 cases in group I(71.43%)and 5 cases in groups II(83.33%)showing deposits of IgA, IgG,IgM.There were 6 cases in group I and 6 cases in group II(100%)showing Complement three deposits.Conclusion:The clinic characteristics in HBV-associated nephritis were variegated,and the pathologic types were complicate.It is essential to be biopsied in time.