尿HBV DNA在乙型肝炎病毒相关性肾炎诊断中的价值

目的探讨尿HBV DNA在乙型肝炎病毒相关性肾炎的诊断价值。方法本研究共入组152例患者，分为3组：乙型肝炎病
毒相关性肾炎组66例，非乙型肝炎病毒相关性肾炎组66例，慢性乙型肝炎无肾损害患者20例。应用PCR方法检测血尿HBV
DNA；乙肝五项定量采用酶联免疫法检测。结果乙型肝炎病毒相关性肾炎患者中尿HBV DNA阳性率33%（22/66），两对照组
中无1例阳性。尿HBV DNA在乙型肝炎病毒相关性肾炎的诊断特异性高达98%，具有良好的阳性预测值（0.96）和阴性预测值
（0.60）。尿HBV DNA或尿HBV DNA与血清HBeAg联合诊断价值优于尿HBV DNA与血清HBV DNA、血清HBsAg、血清
HBeAg联合对乙型肝炎病毒相关性肾炎的诊断价值。结论尿HBV DNA可能作为乙型肝炎病毒相关性肾炎的一种新无创辅
助诊断指标。

Diagnostic value of urine HBV DNA for hepatitis B virus-associated glomerulonephritis

Objective To investigate the potential value of urine hepatitis B virus (HBV) DNA as a new noninvasive diagnostic
indicator for HBV-associated glomerulonephritis (HBV-GN). Methods A total of 152 patients including 66 with HBV-GN, 66
with non-HBV-GN, and 20 with chronic hepatitis B (CHB) without renal disease were examined for serum and urine HBV
DNA levels using polymerase chain reaction (PCR) and for 5 serum HBV markers using enzyme-linked immunosorbent
assays. Results Twenty-two patients (33%) in the HBV-GN group, but none in the other two groups, were found positive for
urine HBV DNA. In the diagnosis of HBV-GN, urine HBV DNA had a high specificity (0.98), a good positive predictive value
(PPV, 0.96), and a modest negative predictive value (NPV, 0.60). Urine HBV DNA, alone or in combination with serum HBeAg,
was superior in the diagnosis of HBV-GN to the combination of urine HBV DNA with serum HBV DNA, hepatitis B surface
antigen and the hepatitis B e antigen. Conclusion Urine HBV DNA may be one of the new noninvasive diagnostic criterion for
HBV-GN.