乙型肝炎病毒相关性肾炎的临床病理特点及治疗

Clinicopathological teatures and treatment of hepatitis B virus associated glomerulonephritis

目的探讨乙型肝炎病毒相关陛肾炎（HBV-GN）的临床病理特点及治疗疗效。方法分析经肾活检确诊的21例HBV-GN患者的病理特征、临床表现，检测乙型肝炎五项（HBsAg、抗．HBs、抗-HBc、HBeAg、抗-HBe）、24h尿蛋白定量，免组化染色检测肾组织中HBsAg和HBcAg，采用激素联合吗替麦考酚酯或来氟米特或环孢素治疗并评定疗效。结果21例患者中男性18例，女性3例，男女比例为6：1；8例（38．1％）临床表现为肾病综合征；血清HBV-DNA阳性率为9．5％（2例）；肾脏病理类型：膜性肾病8例（38．1％），系膜增生性肾小球肾炎6例（28．6％），IgA肾病4例（19．0％），膜增殖性肾小球肾炎3例（14．3％）。肾组织HBsAg阳性、HBcAg阳性检出率分别为71．4％（15例）、85．7％（18例）。7例激素联合来氟米特治疗的患者中，2例完全缓解，5例部分缓解。21例患者治疗后总有效率为85．7％（18／21）。结论HBV-GN以男性多见，临床表现以肾病综合征最常见，病理类型以膜性肾病为主，激素联合来氟米特在HBV-GN治疗中有一定的作用。

Objective To explore the clinical features and curative effect of Hepatitis B virus associated glomerulonephritis（HBV-GN）. Methods The pathology, clinical manifestation of 21 HBV-GN patients diagnosed by renal biopsy were analyzed. HBsAg, anty-HBs, anty-HBc, HBeAg, anti-HBe and urine protein in 24 hours were assayed. HBsAg and HBcAg of nephridial tissue were detected by immunohistochemieal method. The treatment of hormone combined of mycophenolate mofetil or leflunomide, or ciclosporin A were used and the therapeutic effect was assessed. Results There were 21 patients diagnosed of HBV-GN. The ratio of male： female was 6： 1. The clinical symptom of 8 patients （38.1% ） was nephrotic syndrome and HBV-DNA positive rate was 9.5% （2/21）. Of 21 cases, 8 cases were with membranous glomerulonephritis, 6 cases with mesangial proliferative glomerulone- phritis, 4 cases with IgA nephropathy and 3 cases with membrane proliferative glomenrlonephritis. The positive rate of HBsAg and HBcAg in kidney tissues was 71.4% （ 15/21 ） and 85.7% （ 18/21 ）. Of seven patients treated with hormone combined with leflunomide, the condition of 2 cases was complete remission, and others were partial remis- sion. The total effective rate was 85.7% （ 18/21 ）. Conclusions HBV-GN is more common in male. The most common clinical symptom is nephrotic syndrome, and membranous gl0merulonephntis is the most frequent pathologi- cal type. Hormone combined leflunomide has some effect in the treatment of HBV-GN.