膜性乙型肝炎相关性肾炎与特发性膜性肾病临床比较研究

Clinical comparative study of membranous nephritis associated with hepatitis B with idiopathic membranous nephropathy

目的探讨膜性乙型肝炎病毒相关性肾炎（HBV—MN）的临床病理特点及诊治方法。方法回顾性分析比较26例HBV—MN和32例特发性膜性肾病（IMN）临床表现、病理及诊治的异同。结果（1）两组发病年龄、血尿值、HT率、血肌酐值及eGFR较HBV—MN组均明显低于IMN组，差异有统计学意义（P〈0．05或〈001）。（2）两组患者均以I、II期膜性肾病常见，且HBV—MN组表现为多种免疫复合物、多部位高强度沉积，而IMN组以IgG、C3在上皮下和基底膜高强度沉积。（3）治疗方法间比较无明显不同。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、II期膜性肾病常见；激素、霉酚酸酯及拉米夫定临床治疗均有效。

Objective To compare the clinicopathologic features of membranous nephritis associated with hepatitis B （HBV-MN） with idiopathic membranous nephritis （IMN）. Methods The clinicopathological data of 26 patients with membranous nephritis associated with hepatitis B and 32 patients with idiopathic membranous nephropathy were retrospectively reviewed. Results The age of onset, hematuria, HT rate, serum creatinine and eGFR in HBV-MN group were significantly lower than those in IMN group （P 〈0.05 or〈0.01 ）. Phasel and phasell of membranous nephropathy were common in both groups. In HBV-MN group a variety of high-intensive immune complex deposited in different location, but in IMN group high-intensive IgG and C3 deposited in subepithelial tissue and basement membrane. There were not distinct differences in the therapeutic methods of two groups. Conclusion HBV-MN is common in young and middle-age men, the main clinical manifestations are nephrotic syndrome and chronic nephritic syndrome combined with nephrotic syndrome. Glucocorticoid, mycophenolate and lamivudine are effective for treatment of HBV-MN.