乙型肝炎病毒相关性肾炎肾组织中HBV DNA的原位检测

目的：检测HBV DNA在乙型肝炎病毒相关性肾炎肾组织中的分布，探讨乙型肝炎病毒相关肾炎的发病机制。方法：应用针对HBV全基因组的DNA探针进行原位杂交及原位PCR研究，对45例肾炎病人肾组织中的HBV DNA进行检测。结果：肾组织HBV抗原阳性的38例标本中，肾组织HBV DNA的检出率为71%（27/38）；其中，HBV相关肾炎HBV DNA的阳性率为73%（19/26），IgA肾病及狼疮肾炎伴HBV抗原沉积病例HBV DNA的阳性率为67%（8/12）。原位杂交显示HBV DNA以肾小管上皮细胞胞浆分布为主；原位PCR方法可使阳性信号增强，并可见HBV DNA在部分肾小管细胞胞核、肾小球上皮细胞及系膜细胞的胞核和胞浆以及肾小球基底膜内均有分布。结论：HBV在肾组织内存在感染及复制，其在乙型肝炎病毒相关性肾炎的发病机制中具有重要作用。

Detection of HBV DNA in kidneys of HBV-associated glomerulonephritis using in situ hybridization and in situ PCR technique

SUMMARY Objective: To detect the localization of HBV DNA in kidneys of HBV associated glomerulonephritis, and investigate the pathogenesis of HBV associated glomerulonephritis. Methods: 45 cases of renal biopsy specimens (38 cases had glomerular deposition of HBV antigens, 7 cases were negative for serologic and histologic HBV antigens) were examined for HBV DNA by in situ hybridization (ISH) and in situ PCR (IS PCR). Results: The positive rate of HBV DNA in renal biopsy was 71% (27/38) in patients with glomerular deposition of HBV antigens. HBV DNA was found in 19 cases (19/26, 73%) of HBV associated glomerulonephritis; and in 8 cases (8/12, 67%) of IgA nephropathy and lupus nephritis with glomerular deposition of HBV antigens. HBV DNA was detected mainly in the cytoplasm of tubular epithelia with ISH; IS PCR showed that HBV DNA was localized not only in cytoplasm of tubular epithelia, but also in nuclei of tubular epithelia, in nuclei and cytoplasm of glomerular epithelia and mesangial cells, and in GBM. Conclusion: Our study suggested the presence of HBV infection and replication in glomerular cells and renal tubular epithelia, indicating an etiologic role of HBV in HBV associated glomerulonephritis.