乙型肝炎病毒DNA与IgA肾病发病的关系

The Existence and Significance of Hepatitis B Virus DNA in Kidneys of IgA Nephropathy

目的 :探讨乙型肝炎病毒 (HBV)感染与IgA肾病发病的关系。方法 :5 0例血清HBV标志或肾组织HBV抗原阳性的IgA肾病患者作为研究对象 ,应用原位分子杂交技术和Southerblot技术检测肾组织中HBVDNA。结果 :5 0例IgA肾病患者中 ,血清HBsAg阳性 17例 (34% ) ;肾组织HBAg阳性 4 8例 (96 % ) ,HBAg在肾小球中阳性率为 82 % (4 1/ 5 0 ) ,其中HBsAg为 5 8% (2 9/ 5 0 ) ,HBcAg为 4 2 % (2 1/ 5 0 ) ;除了肾小球 ,4 7例 (94 % )患者BsAg和HBcAg肾小管上皮细胞亦有阳性沉积 ,分别为 2 8例 (5 6 % )和 39例 (78% ) ;原位分子杂交证实 5 0例患者肾组织HBVDNA阳性率为 92 % (4 6 / 5 0 ) ,其中肾小管上皮细胞、肾小球细胞HBVDNA阳性率分别为 72 % (36 / 5 0 )和 82 % (4 1/ 5 0 )。Southernblot技术证实在 5 0例患者肾组织中 34例有整合型HBVDNA ,阳性率为 6 8%。结论 :HBV感染与IgA肾病的发病密切相关 。

Objective:To investigate the existence and significance of hepatitis B virus (HBV) DNA in the pathogenesis of IgA nephropathy (IgAN).Methods:Fifty patients of IgAN with HBV antigenaemia and/or hepatitis B virus antigen(HBAg,or HBsAg,HBcAg)detected by immunohistochemistry in renal tissue were enrolled in the study. The distribution and localization of HBV DNA were observed by using in situ hybridization; Southern blot analysis was performed to reveal the state of renal HBV DNA.Results:Among 50 patients with IgAN, HBs antigenemia was detected in 17 patients(34%). HBAg in renal tissues was detected in 48 patients (96%), with a positive rate of HBAg in glomeruli of 82%(41/50), a positive rate of HBsAg of 58%(29/50) and a positive rate of HBcAg of 42%(21/50).Positive rate of HBAg in tubular epithelia was 94%(47/50). HBsAg and HBcAg were also found in tubular epithelial cells with a positive rate 56%(28/50) and 78%(39.50) respectively. Thirty-six out of 50 cases(72%)and 40 out of 50 cases (82%) were proved to be HBV-DNA positive in tubular epithelial cells and in glomeruli respectively by in situ hybridization, which was localized in the nuclei of tubular epithelial cells and glomerular mesangial cells as well as infiltrated interstitial lymphocytes. Thirty-four out of 50 cases(68%) were proved to be HBV-DNA positive by Southern blot analysis and all were of integrated form.Conclusion:There is strong relationship between HBV infection and IgAN. The renal tissues of some IgAN were infected with HBV directly and express HBV DNA in situ. HBV-DNA may play an important role in the pathogenesis of IgAN.