乙型肝炎病毒感染与肾小球肾炎

目的研究乙型肝炎病毒（ＨＢＶ）感染与肾小球肾炎，尤其是与ＩｇＡ肾病（ＩｇＡＮ）、狼疮肾炎（ＬＮ）间的关系，并初步观察α干扰素（αＩＦＮ）对成人乙肝相关性肾炎（ＨＢＶＧＮ）的疗效。方法对１５７例肾活检标本采用免疫组织化学的方法检测肾组织中ＨＢＡｇ，配对比较３２例ＩｇＡＮ，３０例ＬＮ中ＨＢＡｇ阳性组与阴性组肾组织病理改变，和４２例ＧＮ中ＨＢｃＡｇ阳性组与阴性组对激素治疗的反应，并随访３例ＨＢＶＧＮ经αＩＦＮ治疗的临床演变。结果ＩｇＡＮ中ＨＢｃＡｇ阳性组肾小管及间质病变程度均较阴性组严重（Ｐ＜００５）；ＬＮ中ＨＢｃＡｇ阳性组肾小球硬化及间质炎症程度较阴性组显著（Ｐ＜００５）；ＨＢｃＡｇ阳性组对激素治疗的反应较阴性组差（Ｐ＜００５）；３例ＨＢＶＧＮ经αＩＦＮ治疗后临床症状缓解。结论肾小球肾炎部分病例起病与ＨＢＶ感染有关，ＩｇＡＮ、ＬＮ与ＨＢＶ感染有相关性，αＩＦＮ对成人ＨＢＶＧＮ可能有良好的治疗作用。

HBV infection and glomerulonephritis

Objective To investigate the relationship between HBV infection and glomerulonephritis especially with IgA nephropathy,lupus nephritis;also to preliminarily study the effect of IFN on adult HBVGN treatment. Method HBAg were detected by immunohistochemical techniques in renal biopsy specimens from 157 cases of GN;32 cases of IgAN and 30 cases of LN were chosen to compare the degree of pathological changes between renal HBcAg postitive groups and negative groups;The clinical response to steroid therapy was also compared between HBcAg positive group and negative group in 42 cases of GN;3 adult cases of HBVGN was followed up during IFN treatment. Results The renal tubular lesions,interstitial inflammation and fibrosis were more severe in IgAN with HBcAg positive group than that in negative group (P<005).The degree of sclerosed glomeruli and interstitial inflammation was significantly higher in LN with HBcAg positive group compared with negative group(P<005).Contrary to the HBcAg negative group,most of the positive cases were nonresponsive to steroid therapy,some of which even worsened.The clinical symptoms were improved in 3 cases of HBVGN with IFN treatment. Conclusion HBV may play an important role in the pathogenesis of some types of GN.IgAN and LN may be also related to HBV infection.Adult HBVGN has beneficial response to IFN therapy.