乙型肝炎病毒相关性肾小球肾炎39例临床与病理分析

Clinicopathological analysis of 39 cases of hepatitis B virus-associated glomerulonephritis

目的探讨活动性及非活动性乙型肝炎病毒相关性肾小球肾炎（HBV-GN）的临床和病理特点。方法收集本院2004年1月至2010年7月经肾活检确诊的39例HBV-GN患者的临床和病理资料，比较HBV感染活动组与非活动组的临床及病理特点。结果（1）活动组循环补体4（CA）低于非活动组（P〈0．05），肾组织C1q检出率高于非活动组（P〈0．05），IgG、IgM、C3、Clq、HBV核心抗原（HBcAg）平均荧光沉积程度高于非活动组。（2）非活动组肾功能异常的发生率较活动组有升高趋势，且。肾脏病变程度较重（P〈O．05）。结论HBV感染活动组肾脏病理改变相对较轻，其发生可能与补体的参与及免疫球蛋白沉积增加有关。非活动组病理改变较重，且肾功能异常发生率较高。

Objective To study the clinicopathologic features of hepatitis B virus-associated glomerulonephritis （HBV-GN） in patients with active and inactive hepatitis B virus （HBV） infection. Methods Thirty-nine cases of HBV-GN confirmed by renal biopsy from Jan. 2004 to July 2010 were collected, and the clinical and pathological characteristics of patients with active and inactive HBV in- fection were compared. Results （1） The circulating complement 4（CA） was decreased in patients with active HBV infection （P〈0. 05） ; the positive rate of Clq in glomeruli of patients with active HBV infection was significantly higher than in inactive group （P〈0. 05）, and the average fluorescent deposition levels of IgG, IgM, C3, Clq and HBcAg were also higher than in inactive group. （2） Renal dysfunction and pathologic lesions were found more frequently in patients with inactive HBV infection than in active group （P〈0. 05）. Conclusions Compared with the inactive group, the pathological change was mild in active group, and the possible mechanism involves the participation of complement and increase of pathological immunoglobulin deposition. There are severe pathological changes and a higher incidence of renal dysfunction in inactive group.