膜性乙型肝炎病毒相关性肾炎与特发性膜性肾病临床对比分析

Comparative Analysis of Hepatitis B Virus Related Membranous Nephropathy and Idiopathic Membranous Nephropathy

目的:探讨膜性乙型肝炎病毒相关肾炎(HBV-MN)的临床、病理特点及中医证候特征。方法:采用回顾性分析方法,比较27例HBV-MN和31例特发性膜性肾病(IMN)临床表现、肾脏病理及中医证候等方面的异同。结果:(1)临床表现:HBV-MN组发病年龄明显低于IMN组(P<0.05);两组临床表现构成比经Fisher精确卡方检验具有统计学差异(P<0.05)。(2)肾脏病理:两组均以Ⅰ期、Ⅱ期膜性肾病常见,肾脏病理分期无统计学差异(P>0.05);光镜检查,两组肾小球、肾小管间质及肾血管等各项病理积分无统计学差异(P>0.05);免疫荧光检查,HBV-MN组表现为多种免疫复合物、多部位、高强度沉积,而IMN组主要以IgG、C3在上皮下和基底膜高强度沉积。(3)中医证候:本虚证中,两组均以脾肾气虚所占比例最高,而且两组本虚证候分布及各项本虚证候积分均无统计学差异(P>0.05);标实证中,HBV-MN组湿热证所占比例明显高于IMN组(P<0.05),而IMN组中血瘀证和水气证所占比例明显高于HBV-MN组(P<0.05)。HBV-MN组湿热证候积分明显大于IMN组(P<0.05),而IMN组血瘀证候积分明显大于HBV-MN组(P<0.01)。结论:HBV-MN多发于男性中、青年,主要临床表现为肾病综合征、慢性肾炎综合征合并肾病综合征;病理特征为多种免疫复合物、多部位、高强度沉积,以Ⅰ期、Ⅱ期膜性肾病常见;中医证候以脾肾气虚挟湿热为主。

Objective：To investigate the clinical manifestation, pathological characteristics, and similarities and differences of TCM syndrome of HBV- associated membranous nephropathy（IABV- MN）and idiopathic membranous nephropathy（IMN）. Methods： The clinical manifestations, renal pathology and the distribution and semi- quantitative score of TCM Syndrome were compared within the two groups of patients （27 of HBV- MN and 31 of IMN） with urinary protein excretion level. Results： （1） Clinical manifestations：The mean age of the HBV- MN group was significantly younger than that of the IMN group, P〈 0.05. The major clinical syndrome in both groups is nephrotic syndrome, though the constituent ratios of clinical manifestation of both groups are statistically different, P 〈 0.05. （2） Renal pathology： The pathology staging of both group were mainly MN stage I and Ⅱ , without significant statistical difference; no significant difference between the two groups in the glomerular, tubular and vascular lesions were observed by lightmicrcscope. Immunofluorescence discovery of the HBV- MN group was various immunecomplex deposition in more spots with high intensity than that of the IMN group, while there were only IgG and C3 deposition at the subepithelial and GBM area in IMN group. （3）TCM syndrome： The difference of scores and ratio of the vital deficiency syndrome between the two groups didn＇ t reach a significant level, with qi deficiency of both of the spleen and the kidney being the most common of both groups, P 〉0.05; in the excessiveness syndrome, the proportion and score of damp- heat syndrome of the HBV- MN group were significantly higher than that of the IMN group （P〈0.05,respectively）;and the proportion and score of blood-stasis syndrome and of water-retention syndrome of the IMN group were significantly higher than that of the HBV MN group （P〈0.05, and P〈 0.01, respective- ly） .Conelusion：HBV - MN mainly affects male patients of the young to middle-aged, with the main clinical manifestation of nephrotie syndrome and nephritic plus nephritic syndrome; The main pathological characteristic is stage I and Ⅱ atypical MN, with an immunofluorescence discovery of various immunecomplex deposition in multiple spots and intensity; the main TCM syndrome of HBV-MN is qi deficiency of both of the spleen and the kidney,with dampheat as the main pathogenic factor.