乙型肝炎病毒相关性肾炎的中西医结合治疗

乙型肝炎病毒相关性肾炎(HBV-GN)的研究已40余年。其发病机制仍不十分明确，可能与病毒介导的免疫反应有关。HBV－GN诊断标准为：(1)血清HBV抗原阳性；(2)确诊为肾小球肾炎；(3)肾组织中找到HBV抗原，其中(2)，(3)为必要条件。在诊断HBV-GN时应注意排除肾组织HBV标志物假阳性；排除HBV肾组织沉积伴发原发性肾炎；注意与狼疮肾炎的鉴别。HBV-GN的肾脏病理以膜性肾病及膜增生性肾炎常见。HBV-GN以肾病综合征及轻微的血尿为主要临床表现。儿童HBV-GN患者的病程多呈自限性，而成人HBV-GN则常呈缓慢进展，常发展为慢性肾功能衰竭。关于HBV-GN治疗的临床报道很多，多为无对照或小样本的回顾性研究，尚无统一的治疗原则可循。抗病毒治疗对HBV-GN有一定疗效，而激素和免疫抑制剂的使用尚存争议。抗病毒药[干扰素或核苷类]＋免疫抑制剂[激素和(或)其他免疫抑制剂]＋中药(辨证施治)的治疗模式，可能是较好的选择。

Treatment of hepatitis B virus-associated glomerulonephritis with integrated traditional Chinese and western medicine

Hepatitis B virus-associated glomerular nephritis (HBV-GN) has been studied for over 40 years, but its detailed pathogenesis has not been identified yet, and may be related to HBV-mediated immune reaction. The diagnostic criteria of HBV-GN are comprised of three items; (1) serum HBV antigens are positive, (2)glomerular nephritis is confirmed; (3) HBV antigens are detected in renal tissues; items (2) and (3) are necessary conditions. When HBV-GN is being diagnosed, the following items must be considered: ruling out false positive HBV markers; ruling out primary glomerulonephritis accompanied with HBV deposition in renal tissues; and distinguishing HBV-GN from lupus nephritis. HBV-GN renal pathology is commonly comprised of membranous nephropathy and membranoproliferative nephritis. Nephrotic syndrome and mild hematuria are the main clinical manifestations of HBV-GN. Child HBV-GN is usually self-limited, while adult HBV-GN often slowly progresses into chronic renal failure. There have been a lot of reports about HBV-GN treatment, most of which were retrospective studies without control, and there has not been a unified treatment principle to follow. Antiviral treatment has certain effect for HBV-GN, while there remains controversy about using corticosteroids hormone and immunosuppressive agents. Probably the most viable treatment regimen consists of antiviral drugs (interferon and/or nucleosides), immunosuppressive agents (corticosteroids hormone and/or other immunosuppressive agents), and traditional Chinese medicine (syndrome differentiation treatment).