血清乙型肝炎病毒抗原阴性及抗体阳性肾损害患者的临床病理分析

Clinical and pathological analysis of kidney injury patients with negative serum antigen and positive antibody of hepatic B

目的研究血清乙型肝炎病毒(HBV)抗原阴性、抗体阳性伴有肾损害患者的临床及病理特点。方法选取HBV血清抗原阴性、抗体阳性伴有蛋白尿的住院患者,所有患者均行常规实验室检查及肾脏穿刺活组织病理检查,并采用间接免疫荧光法检测患者肾脏组织的HBsAg和HBcAg,分析其临床及病理特点。结果共收集到血清抗原阴性、抗体阳性伴有蛋白尿的患者21例,7例临床表现为肾病综合征,14例表现为非肾病综合征性蛋白尿。其中仅血清HBcAb阳性者3例,HBsAb+HBcAb阳性者10例,HBeAb+HBcAb阳性者1例,HBsAb+HBeAb+HBcAb阳性者7例,所有患者血清HBV-DNA滴度均<500拷贝/mL。根据肾脏穿刺活组织病理检查结果最后拟诊为HBV相关性肾炎的患者7例。结论对于临床上血清HBV抗原阴性、抗体阳性并伴有蛋白尿的患者,要重视肾脏穿刺活组织检查,尤其要注意对肾脏活组织标本进行HBV抗原的检查。

Objective To investigate the clinical and pathological characteristics in kidney injury patients with negative serum antigen and positive antibody of hepatic B.Methods A total of 21 negative serum hepatitis B virus （HBV） antigen and antibody positive patients with kidney injury were included in this study.All of them received routine laboratory analyses and renal biopsy.HBsAg and HBcAg in renal tissues were detected by indirect immunofluorescence assay.Results Seven of the 21 patients had severe proteinuria and were diagnosed as nephrotic syndrome,14 had non-nephrotic proteinuria.Three patients were only serum HBcAb positive,10 were serum HBsAb＋HBcAb positive,7 were HBsAb＋HBeAb＋HBcAb positive,and 1 was HBeAb＋HBcAb positive.The HBV-DNA copies were lower than 500 copies/mL in all patients.Renal biopsy showed that there were 7 patients had HBV associated glomerulonephritis.Conclusion It is suggested that renal biopsy,especially the HBV-antigen detection in renal tissue is very important for the patients with kidney injury,negative HBV antigen,and positive HBV antibody.（Shanghai Med J,2010,33：363-366）