乙型肝炎病毒相关性肾炎患儿的肝脏病变

Liver lesions in children with hepatitis B virus associated glomerulonephritis

目的乙型肝炎病毒相关性肾炎(HBVGN)是我国常见的继发性肾小球疾病之一,以往人们只关心HBVGN时肾脏病变的问题,对无明显肝脏临床症状的“病毒携带者”或轻微的临床患者的肝脏的情况没有引起注意。该文探讨HBVGN时肝脏的病理变化。方法选择13例HBVGN患儿同时进行肝肾病理活检。结果13例患儿均有肝组织不同程度的受累,主要以轻度肝脏病理改变为主(9/13,占69.2%),HBV抗原在肝组织中主要以HBsAg检出率为高(10/13例,占76.9%);肾病理改变以膜性肾病为主(9/13,占69.2%),其次为系膜增生性肾炎(4/13例,占30.8%),HBV抗原在肾组织HBsAg和HBcAg的检出率均达100%,几乎所有的肾小管间质中有HBV抗原成分的分布。肝组织与肾组织中同时出现HBcAg的有4例。结论HBVGN患儿均有不同程度的肝损害,而肾及肝组织病理改变不一定呈平行关系,肝组织与肾组织中同时出现HBcAg时肝肾同时损害均较重。提示对于HBVGN患者要重视肝肾同治。

Objective To investigate the pathological changes of liver in children with hepatitis B virus associated glomerulonephritis （HBV-GN）. Methods Thirteen children with HBV-GN （aged from 2-14 years） underwent renal and liver biopsy. The biopsy findings were analyzed. Results Different degrees of hepatic lesions were seen in all of the 13 patients, mild lesions accounting for 69.2% （9/13）. HBSAg positive was the most common in the liver tissue [ 76.9% （10/13） ]. Among the renal lesions, membranous glomerulopathy accounted for 69. 2% （ 9/13 ）, followed by membranoproliferative glomerulonephritis 30.8% （ 4/13 ）. HBsAg and HBcAg positive were presented in all patients＇ kidney tissues. HBV antigens were detected in stroma between nephric tubule in all samples. Four patients presented with HBcAg positive in both live and kidneys. Conclusions The children with HBV-GN couple with liver lesions. The severity of the renal lesions is not always accord with that of the liver lesions. The appearance of HBcAg in both kidneys and liver indicates severe lesions of the two organs. It is suggested that a liver-kidney holistic treatment is necessary for children with HBV-GN.