乙型肝炎病毒相关性肾炎临床诊断的探讨

Study on Clinical Diagnosis of Hepatitis B Virus Associated Glomerulonephritis in Children

目的 探讨乙型肝炎病毒相关性肾炎 (HBV GN)的临床诊断的可靠性。方法 对经临床诊断为HBV -GN患儿进行肾穿病理检查 ,比较临床诊断和病理诊断的符合度及两组临床特征的差异。结果 临床诊断为HBV -GN患儿行肾活检分析 ,69例符合病理诊断标准 ,2 9例排除HBV- GN。HBV GN临床诊断和病理诊断高度相关 ,有显著差异P <0 .0 1 ,HBV GN临床诊断的敏感性 94.5 % ,特异性 93 .2 % ,准确性 93 .4 % ,漏诊率 5 .5 % ,误诊率 6 .8%。临床与病理诊断符合组与不符合组年龄、HBV标志分布上有显著性差异 ,诊断符合组中 <6岁患儿比例高于诊断不符合组 (58%vs 1 4 % ) ,HBV大三阳 (HBsAg、HBeAg和HBcAg阳性 )比例也高于诊断不符合组 (80 %vs 66 % ) ,有显著性差异P <0 .0 5 ,而其他临床表现无显著性差异。结论 HBV GN临床诊断有较大的实用价值 ,可用于基层医院 ,但在应用时应注意此诊断方法有少量漏诊和误诊。

Objective To study the reliability of clinic diagnosis of hepatitis B virus(HBV)-associated glomerulonephritis.Met- hods Renal biopsy was carded out in 103 cases with clinically-diagnosed HBV-associated glomerulonephritis. The diagnostic consistency and clinical difference were evaluated.Results Sixty nine cases with clinically-diagnosed HBV-associated glomerulonephritis were confirmed through renal biopsy, 29 cases were excluded from HBV-associated glomerulonephritis. The pathologic diagnosis and clinical diagnosis methods were highly correlated and has significant difference(P<0.01).For HBV-GN, the clinical diagnostic method was 94.5% in sensitivity, 93.2% in speciticity and 93.4% in accuracy, and the rate of underdiagnosis was 5.5% and the rate of misdiagnosis was 6.8%. The age and HBV marker distributions were significantly different in renal biopsy proved cases from excluded cases.The percentage of cases under 6 years old was higher in biopsy-proved cases than in excluded cases (58% vs 14%), and the percentage of HBV HBsAg、HBeAg and HBcAg positive cases was higher in biopsy-proved cases than in excluded cases (80% vs 66%),P<0.05. But no other differences were observed.Conclusion The clinical diagnostic method for HBV-GN had preferable practicablevalue especially in hospitals without biopsy facilities, but some underdiagnosis and misdiagnosis might be produces when applied.