25例乙型肝炎病毒相关性肾炎临床及病理特点

目的探讨乙型肝炎病毒相关性肾炎(HBV-GN)的临床表现、肾脏病理改变及与肝肾损害的关系,为HBV-GN早期诊治提供依据。方法对肾内科2001年11月-2011年11月10年间经肾活检确诊HBV-GN并资料完整的25例患者临床及病理特点进行回顾性分析。结果本组患者占同期肾活检4.70%,患者男性14例(56%),女性11例(44%);发病年龄9～47岁,平均22.83岁;乙肝标记物大三阳者12例(46.8%),乙肝小三阳者9例(36%);临床表现为肾病综合征14例(56%),肾功能不全6例(24%),肝功能受损8例(32%);肝功能是否异常和肾脏临床表现及病理类型无明显差异;病理表现以膜性肾病为主,占12例(48%)。结论 HBV-GN患者以青少年为主,性别差异不大;临床表现主要是肾病综合征为主,病理以膜性肾病多见;HBV血清标志物阴性不能完全排除HBV-GN诊断;HBV对肝脏及肾脏的损伤具有不同步性。

Pathological and Clinical Features of 25 cases with Hepatitis B Virus-associated Nephropathy

Objective To investigate the clinical and pathological features in patients with HBV associated glomerulonephritis(HBV-GN) and their relationships with the renal and hepatic injury,and provide evidences for its early diagnosis.Methods The data of 25 patients with HBV-GN confirmed by renal biopsy from November 2001 to November 2011 were collected,and the clinical and pathological features were analyzed retrospectively.Results HBV-GN accounts for 4.70% of all renal biopsies at the same period of time.Among them,14(56%) patients were male,11(44%) was female.The onset age was from 9 to 47 and average was 22.83 years old.12 cases(46.8%) were with HBsAg,HBeAg and HBcAg positivity,and 9 cases(36%) with HBsAg,HBeAb and HBcAg positivity.14(56%) patients presented the nephrotic syndrome,6(24%) suffered kidney dysfunction;8(32%)patients with liver function damage.There was no correlation between the liver dysfunction and the clinic manifestation and renal pathology.The membranous nephropathy(MN) was the most frequent type(48%) in pathological features.Conclusion Most of the patients with HBV-GN are the youngsters,and there is no apparently gender difference.Nephrotic syndrome is the most common clinic manifestation and membranous nephropathy is most frequent type in pathological features.Negative serum markers of HBV cannot exclude completely of HBV-GN.HBV-GN patients have no synchronized lesions in kidney and liver.