68例伴有肾组织乙肝病毒抗原沉积的肾炎患者临床和病理分析

目的：探讨血清乙肝病毒（HBV）标志物与肾组织HBV抗原沉积、肾病理之间的关系，了解乙肝病毒相关性肾炎（HBV—GN）的临床和病理特点。方法：收集成人肾组织中检测到HBsAg和／或HBcAg沉积的肾炎患者68例（以下称沉积阳性组）。随机抽取同期肾穿合并有慢性乙型肝炎但肾组织中不伴HBsAg和／或HBcAg沉积的肾炎患者24例作为对照组（以下称沉积阴性组）。两组均采用间接免疫荧光法检测肾活检组织冰冻切片中HBsAg和HBcAg，荧光定量PCR法检测血清HBV—DNA水平。结果：（1）两组患者在血压、血尿和蛋白尿程度以及肾功能水平均无统计学差异；（2）沉积阳性组肾病理以IgA肾病（IgAN，占51．5％）和不典型膜性肾病（MN，占38．2％）为主；沉积阴性组则以系膜增生性肾炎（MsPGN，占50％）为主；（3）68例患者中13例血清HBV标志物阴性或仅有HBsAb阳性，血HBV—DNA病毒载量〈100拷贝／ml的患者肾组织中检测到HBsAg和俄HBcAg沉积，且免疫荧光显示免疫球蛋白和补体沉积均在3种以上，满堂亮者7例（53．8％）：光镜显示不典型MN9例（69．2％），IgAN3例，MPGN1例。结论：对于成年人依据临床难作出HBV—GN诊断。成人HBV—GN病理表现具有多样性，以IgAN和不典型MN为主，其次为MPGN和MsPGN，FSGS少见；肾组织HBV抗原沉积现象可以出现在血清HBV标志物阴性或仅HBsAb阳性的患者，提示应重视肾组织HBV抗原检测，尽可能降低HBV—GN的漏诊率，尤其是血清HBV标志物阴性的患者。

Clinicopathological Analysis for Nephritis Accompanied by Hepatitis B Virus (HBV) Antigens Depositing in Glomeruli in 68 Cases

Objective:To investigate clinicopathological features of HBV related glomerulonephritis(HBV-GN), the deposition of HBV related antigens in glomeruli were examined,and the association between serum markers of HBV and antigen deposition as well as the pathological manifestations were investigated.Methods:68 cases patients with deposition of HBV related antigens in glomeruli were involved in this study (group A). 24 cases without depositing were divided into group B. Detecting HBsAg and HBcAg in renal tissues by indirect immunofluorescence, and serum HBV-DNA by polymerase chain reaction.Results:The blood pressure,hematuria, albuminuria, renal function are indifferent between the two groups (P>0.05).In group A,the major renal pathological categories are IgA nephritis (IgAN,51.5%) and atypical membranous changes(MN,38.2%), the next are membranoproliferative changes (MPGN) and mesangial proliferative changes (MsPGN). In group B,the major are MsPGN (50%).Serum markers of HBV are all negative in 6, and only HbsAb positive in 7 In group A. The renal pathological categories of these 13 cases are MN in 9, IgAN in 3 and MPGN in 1.13 cases with markers negative or only HbsAb positive can be found antigens depisition in glomeruli, whose copy of virus are all below 103 per millilitre and the depositions of immunoglobulins and complements are multiple,"full-lighes"in 7cases(53.8%), light microscope showed atipical MN in 9(69.2%),IgAN in 3,MPGN in 1.Conclusion:It is difficult for adults to diagnose HBV-GN according to clinical features. The pathological manifestations of adults HBV-GN are diversified, the major are IgAN and atypical MN, the next are MPGN and MsPGN, FSGS is rare. People with HBV markers negative or only HbsAb positive can also be found HBV antigens depisition in glomeruli, which signified the importance of renal tissue examination of HBV antigens,espically those patients with negative blood HBV markers.