乙型肝炎病毒基因型和基因变异在乙型肝炎病毒相关性肾小球肾炎中的意义

目的探讨HBV基因型及基因变异等病毒因素在乙型肝炎病毒相关性肾小球肾炎（HBV-GN）中的意义。方法选择41例HBV-GN患者，采用荧光PCR法检测HBV-GN患者基因型，HBV多态性芯片检测基因变异，同时测定尿常规、肾功能和血压等临床资料。结果41例HBV-GN患者，B基因型14例，C型24例（86．8％），B＋C混合型3例。B型和C型患者间24h尿蛋白有显著性统计学差异（P〈0．05），尿红细胞计数、血压、尿素氮和血清肌酐无显著性统计学差异（均P〉0．05）。12例为前C区1896位变异，1896位变异与未变异者间小便常规，血压和肾功能无显著性差异。结论HBV-GN患者HBV基因以B、C两型为主，C型为多。C型患肾脏损害可能更为严重。前C区1896位变异和YMDD变异对HBV-GN患者小便常规、血压和肾功能无明显影响。

Clinical significance of HBV genotype and mutations in hepatitis B virus associated glomerulonephritis

Objectives Hepatitis B virus-associated nephritis （HBV-GN） is known as an immune-mediated disorder. Little is known about the role of HBV genotype and HBV DNA mutations in HBV-GN. To explore the role of HBV genotype and HBV DNA mutations in HBV-GN, HBV genotypes and HBV DNA mutations were examined in 41 patients with HBV-GN. Methods HBV genotype and HBV DNA mutations （precore 1896 and YMDD） were determined by restriction fragment length polymorphism techniques. Clinical data, including blood pressure, urine protein in 24 hours, erythrocytes in urine, BUN, and serum creatine, were collected. Results Among 41 patients with HBV-GN, HBV genotype B, C, and B plus C were found in 14 （34.1%） 24 （58.5%）, and 3 （7.4%）, respectively; There was a significant difference in urine proteins in 24 hours between patients with HBV genotype B and C （P〈0.05）. No significant difference was found in blood pressure, BUN, serum creatine, and urine erythrocyte between patients with HBV genotype B and C （all P〉0.05）; no significant difference in blood pressure, BUN, serum creatine, urine protein, and urine erythrocyte was showed between patients infected with HBV DNA precore 1896 mutation and those with wildtype, as well as patients with HBV DNA YMDD mutation and those with wildtype （all P〉0.05）. Conclusions HBV genotype B and C, especially genotype C, predominate in patients with HBV-associated nephritis. Patients with HBV genotype C may have more serious renal damage. HBV-DNA precore 1896 mutation and YMDD mutation have little influence on severity and course of HBV-GN.