呈肾病综合征的乙型肝炎病毒相关性肾炎临床病理特点

Clinicopathological Features of Hepatitis B Virus-associated Glomerulonephritis Patients with Nephrotic Syndrome

目的:探讨呈肾病综合征(NS)的乙型肝炎病毒相关性肾炎(hepatitis B virus-associated glomerulonephritis,HBV-GN)的临床病理特点。方法:回顾性分析呈NS且肾穿组织内小动脉≥5条的HBV-GN患者152例的临床病理资料,光镜下观察其肾内小动脉病变,比较伴与不伴肾内小动脉病变患者的临床病理资料。结果:平均年龄26.3岁,男∶女为3.6∶1;伴高血压者36例(23.7%)、贫血52例(34.2%)、肾衰竭者33例(21.7%)、肝功能异常者20例(13.2%)。乙肝大三阳者87例(57.2%);血清和肾组织内HBV-DNA载量呈正相关(P<0.01)。病理表现以膜性肾性(MN)、系膜增生性肾炎(MsPGN)、膜增生性肾炎(MPGN)为主;未成年组与成年组MN、MPGN所占比例不同(P<0.05)。伴有肾内小动脉病变者84例(55.2%),与无肾内小动脉病变者相比,其高血压发生率较高(P<0.05),24h尿蛋白定量显著较高(P<0.01),贫血、肾间质纤维化的发生率显著较高(P<0.01)。结论:呈NS的HBV-GN患者绝大多数为HBV携带者且伴有病毒复制,病理以MN、MsPGN及MPGN为主,半数以上伴有肾内小动脉病变,伴有肾内小血管病变者高血压、贫血及肾小管间质纤维化发生率较高,蛋白尿更严重,为预后不良的病理学指标。

Objective ：To Investigate the clinicopathological features of hepatitis B virus -associated glomerulonephritis pa- tients with nephrotic syndrome. Methods：The clinical and pathological data of 152 cases with nephrotic syndrome and renal biopsy tis- sue small artery crosssectional ≥5 of HBV -GN were analyzed retrospectively. Small intrarenal arterial lesions（SRAL） were observed, and the clinical and pathological data in patients with or without SRAL were compared. Results：Among them, there was a 3.6：1 predominance of males, mean age was 26.3 years,36 （23.7%） patients broken out with hypertension, 52 （34.2%） with ane- mia, 33（21.7% ） suffered renal dysfunction, 20（ 13.2% ） liver function were impaired, 87（57.2% ） serum HBsAg,HBeAg,HBcAb were all positive. With the rising of the content of HBV - DNA in serum,it increases in renal biopsy tissue （P 〈0.01 ）. The MN, MsPGN, MPGN were common renal histological types. 84 （55.2%） of patients had SRAL. The incidence of hypertension, anemia and renal tubulointerstitial fibrosis in patients with SRAL were higher than that in patients without SRAL （ P 〈 0.05 ）. The patients with SRAL had a higher urinary protein level. Conclusion： The most patients of HBV - GN with nephrotic syndrome are HBV carriers. Renal histological consists of many types, MN is the most common type. SRAL have a close relationship with hypertension, anemia and tubulointerstitial fibrosis,that suggest SRAL indicate a poor prognosis of those patients.