伴有与无肾组织乙肝病毒抗原沉积的IgA肾病患者临床和病理对比分析

Comparison of Clinical and Pathological Features in IgA Nephropathy Patients with and without Renal Deposition of Hepatitis B Virus Antigens

目的了解伴有与无肾组织乙肝病毒抗原沉积的IgA肾病患者临床和病理特征,探讨乙肝病毒(HBV)感染与IgA肾病的关系。方法选择2008年12月至2011年12月在北京大学深圳医院住院、并行肾组织活检确诊的IgA肾病患者316例,其中伴HBsAg和(或)HBcAg肾小球沉积的患者(研究组)25例(7.9%),无HBsAg和(或)HBcAg肾小球沉积的患者(对照组)291例(92.1%)。2组患者均行肾组织活检,其标本分别常规进行光学显微镜、免疫荧光及电镜检测,以及血清HBV感染标志物、肌酐、胆固醇、白蛋白、C3、IgA和24h尿蛋白水平的检测,同时对2组患者肾脏病变按肾小球活动病变积分、肾小球慢性病变积分及肾小管间质积分进行评定。结果2组患者肾小球活动病变积分及肾小球慢性病变积分比较差异均无统计学意义(均P>0.05),研究组患者肾小管间质积分明显高于对照组(P<0.05)。研究组患者肾组织C1q沉积所占比例略高于对照组,但差异无统计学意义(P>0.05)。研究组患者血清HBV感染标志物阳性率显著高于对照组(P<0.01)。结论乙肝病毒抗原在肾组织中沉积与IgA肾病发病并无直接关系,但有可能加重了肾小管间质的损害。

Objective To investigate the clinical and pathological features of IgA nephropathy with or without renal deposition of hepatitis B virus（HBV） antigens,and to explore the relationship between IgA nephropathy and HBV infection.Methods A total of 316 patients with IgA nephropathy confirmed by renal biopsy at Peking University Shenzhen Hospital from December 2008 to December 2011 were selected in this study,including 25 patients with glomerular deposition of HBsAg and/or HBcAg（study group） and 291 patients without HBsAg and/or HBcAg deposition（control group）.Renal biopsy specimens were examined by optical microscopy,immunofluorescence and electron microscopy.Serum HBV markers,creatinine,cholesterol,albumin,C3,IgA and 24-hour urinary protein excretion were detected,and scores of glomerular active lesions,glomerular chronic lesions and tubulo-interstitial lesions were measured in both groups.Results There were no significant differences in scores of glomerular active lesions and glomerular chronic lesions between the two groups（all P〉0.05）.But scores of tubulo-interstitial lesion and positive rates of HBV infection in study group were significantly higher than those in control group（P〈0.05 or P〈0.01）.Furthermore,the study group had a slightly higher levels of C1q deposition than control group,but the difference was not statistically significant（P〉0.05）.Conclusion Renal deposition of HBV antigens is not correlated with IgA nephropathy,but may aggravate tubulo-interstitial damage.