HBV相关性肾炎患者临床与病理特点分析

目的:分析HBV相关性肾炎(肾组织内可检测到HBV抗原沉积)的临床和病理特点,为其诊断、治疗提供依据。方法:53例血清HBV标记均阳性的肾小球肾炎患者,对肾组织HBV标记物阳性和阴性患者的临床、病理和实验室检查资料进行对照分析。结果:53例血清HBV标记物阳性患者中HBV相关性肾炎的发生率为43.4%(23/53);HBV相关性肾炎临床上主要表现为肾病综合征(14/23,60.87%),主要病理类型为膜性肾病(11/23,47.80%)和膜增生性肾小球肾炎(5/23,21.7%);和非HBV相关性肾炎组相比:肌酐清除率降低((128.64±32.32)μmol/Lvs(88.57±12.25)μmol/L,P<0.05),24h尿蛋白排泄率升高((3.02±0.95)g/24hvs(1.84±0.68)g/24h,P<0.05),肾小管上皮细胞中HBcAg的阳性率较高。结论:HBV相关性肾炎患者和非HBV相关性肾炎患者在临床表现、病理类型和实验室检查方面有不同;对血清HBV标记物阳性的肾炎患者治疗前须行肾穿刺病理检查,必要时进行抗病毒治疗。

Analysis on the clinical and pathological features of HBV-related glomerulonephritis

Aim: To analyze the clinical and pathological features of HBV-related glomerulonephritis and to provide foundation for its diagnosis and treatment. Methods: The clinical data, pathological and laboratory results of 53 glomerulonephritis patients with serum HBV marker positive were analyzed. Results: The incidence of HBV-related glomerulonephritis(positive group) was 43.4%. Among these patients, nephritic syndrome(60.87%) was the main manifestation, while membranous nephropathy(47.80%) and membranous proliferative glomerulonephritis(21.70%) were the principal pathological types. The creatinine clearance rate in positive group was lower than that of group in which HBV marker was negative (control group), while the output rate of urine protein was higher than that of control group(P<0.05). Conclusion: There are differences in clinical manifestations, pathological types and laboratory results between positive group and control group. It is necessary to perform biopsy before determining treating regime for HBV-related glomerulonephritis.