小儿乙型肝炎病毒相关性肾炎临床病理分析

目的:探讨小儿乙型肝炎病毒相关性肾炎(HBV-GN)的临床特点及病理特点。方法:对我科自1984年~2007年3月间经皮肾活检病理检查确诊的36例小儿乙型肝炎病毒相关性肾炎患者的临床及病理类型进行回顾性分析。结果:36例小儿HBV-GN患者,临床类型以肾病综合征(NS)最为常见,33例(91.7%),其次为肾小球肾炎3例(8.3%);病理类型以膜性肾病(MN)为主,21例(58.3%),其次为系膜增生性肾炎(M sPGN),10例(27.8%),膜增生性肾炎(MPGN),3例(8.3%),毛细血管内增生性肾炎(EnPGN),2例(5.6%);免疫荧光检查呈多种免疫复合物沉积;肾组织中乙肝病毒标志物阳性占27例(75.0%)。结论:小儿HBV-GN患者学龄期多见,且男性多于女性;临床类型以NS居多,病理类型以MN多见,且多样化,对血清乙肝标志物阳性并伴有肾脏损害临床表现的患儿应及早做肾活检。

Clinical and pathological analysis on hepatitis B virus - associated glomerulonephritis in children

Objective To investigate the clinical and pathological characteristics of hepatits B virus-associatedglomerulonephritis(HBV-GN)in children.Method The clinical manifestation and pathological findings of 36 children with HBV-GN in our hospital from March 1984 to March 2007 were investigated retrospectively.Results Among 36 children with HBV-GN diagnosed by renal biopsy,nephrotic syndrome was the the most common clinical manifestation(33 cases,91.7%),followed by glomerular nephritis(3cases,8.3%).Membranous nephropathy(MN) was the most common pathological change(21 cases,58.3%),followed by mesangial proliferative glomerulosclerosis(MsPGN,27.8 %),membranoproliferative nephritis (MPGN,8.3%) and endocapillary proliferative glomerulonephritis(EnPGN,5.6%).In the patients with HBV-GN,immunofluorescence microscope(IF) result showed variety immune complex deposits.HBV markers of renal tissues were positive in 27 cases,with the rate of 75.0%.Conclusion HBV-GN often happens in school age children,and HBV-GN is more common in male than in female.The clinical manifestation and pathological findings are diversification,and the predominantly presenting features are nephrotic syndrome and membraneous nephropathy.Once the marker of HBV is positive and kidney function is abnormal in children,renal biopsy should be carried out as soon as possible.