乙型肝炎病毒相关性肾炎13例临床与病理分析

Clinic and Pathologic Characteristics of HBV-Associated Nephritis

目的 :探讨乙型肝炎病毒相关性肾炎的临床与病理特点。方法 :经临床病理活检确诊的乙型肝炎病毒相关性肾炎患者 13例 ,根据乙型肝炎免疫组织化学染色结果分为两组 :Ⅰ组 (HBsAg阳性组 ) :7例 ;Ⅱ组 (HBsAg +HB cAb阳性组 ) :6例。并对两组的临床诊断、病理类型及免疫荧光的情况进行分析。结果 :①临床诊断 :I组 :肾病综合征 4例 (占 5 7.14 % ) ,慢性肾炎 2例 (占 2 8.5 7% ) ,急性肾炎 1例 (占 14 .2 9% ) ;II组 :肾病综合征 (占 83.33% ) ,慢性肾炎 1例 (占 16 .6 7% ) ;②病理类型 :I组 :膜性肾病 2例 (占 2 8.5 7% ) ,系膜增生 2例 (占 2 8.5 7% ) ,弥漫硬化 1例 (占 14 .2 9% ) ,膜增殖 2例 (占 2 8.5 7% ) ;II组 :膜性肾病 3例 (占 5 0 % ) ,系膜增生 1例 (占 16 .6 7% ) ,弥漫硬化 2例 (占 33.33% ) ;③免疫荧光 :免疫球蛋白沉积以IgA +IgG +IgM为主 ,其中I组 5例 (占 71.4 3% ) ,II组 5例 (占83.33% ) ,补体C3沉积I组 6例 (占 85 .71% ) ,II组 6例 (占 10 0 % )。结论 :乙型肝炎病毒相关性肾炎 ,临床表现多样化 ,病理轻重不一 ,易误诊 ,应肾活检。

Objective:To study clinic and pathologic features of 13 cases of HBV-associated nephritis.Methods:According to the result of immunobistochemistry in renal histocyte of 13 cases of HBV-associated nephritis,the patients were divided into HBsAg group(group I)and HBsAg and HBcAb group(group II);and their clinical diagnosis,pathologic type and immunohistofluorescence were analyzed.Results:1.The clinical: In group I there were 4 cases were diagnosed with nephropathy syndrome(57.14%),2 cases with chronic golmerulonephritis(28.57%),I case with acute glomerulonephritis(14.29%).While in group II there were 5 cases were diagnosed with nephropathy syndrome (83.33%) and 1 case with chronic glomerulonephtitis(16.67%);2.Pathologic types:2 cases of group I were diagnosed with membranous nephropathy type(28.57%),2 cases with mesangialproliferative glomerulonephritis types(28.57%),1 case with diffuse sclerosing glomerulonephritis(14.29%),and 2 cases with membranoprolirerative glomerulonephritis type(28.57%).3.cases of II group were diagnosed membranous nephropathy type(50%).1 case of II group was diagnosed mesangical proliferative glomerulonephritis type(16.67%).2 cases of II group were diagnosed diffuse sclerosing glomerulonephritis(33.33%);3.Immunohistofluorescence:there were 5 cases in group I(71.43%)and 5 cases in groups II(83.33%)showing deposits of IgA, IgG,IgM.There were 6 cases in group I and 6 cases in group II(100%)showing Complement three deposits.Conclusion:The clinic characteristics in HBV-associated nephritis were variegated,and the pathologic types were complicate.It is essential to be biopsied in time.