肾组织preS1/S2-Ag检测在乙型肝炎病毒相关性肾炎诊断中的作用

Role of renal preS1 /S2-Ag and other HBV antigen determination in diagnosis of HBV-associated glomerulonephritis

目的:观察前S1/S2抗原(preS1/S2-Ag)及其它乙型肝炎病毒(HBV)抗原在HBV相关性肾小球肾炎(HBV-GN)患者肾组织中的表达,探讨它们在HBV-GN诊断中的应用价值。方法:回顾性收集2003年1月～2013年1月于中山大学附属第三医院肾内科住院的患者,并符合以下入组标准:血清学HBsAg阳性;有血尿、蛋白尿等临床表现;经肾组织活检病理诊断为肾小球肾炎病变;排除合并有系统性红斑狼疮、过敏性紫癜、糖尿病、丙肝等疾病。入组共49例。用免疫组织化学的方法对其肾组织石蜡切片进行preS1/S2-Ag、HBeAg、HBsAg和HBcAg检测。随机选取5例HBsAg阴性的肾小球轻微病变患者,5例HBsAg阳性的非肾小球肾炎患者作对照。结果:49例HBV感染合并肾小球肾炎患者中preS1/S2-Ag、HBeAg、HBsAg和HBcAg检出阳性率分别为32.7%(16例)、38.8%(19例)、14.3%(7例)和46.9%(23例),总阳性率为70.2%(36例);preS1/S2-Ag主要表达在肾小管上皮细胞、肾小球系膜细胞和内皮细胞胞质内;其表达与肾组织HBcAg的表达呈正相关(r=0.459,P<0.01)。5例HBsAg阴性的肾小球轻微病变患者,4种抗原均未检测到;5例HBsAg阳性的非肾小球肾炎患者有2例表达HBeAg,1例表达HBcAg,无1例表达preS1/S2-Ag及HBsAg。结论:HBV-GN患者肾组织中检测到preS1/S2-Ag;preS1/S2-Ag、HBeAg、HBsAg和HBcAg联合检测可提高HBV-GN的临床诊断率。

AIM：To detect the expression of preS1/S2 antigen （preS1/S2-Ag） and other antigens of hepatitis B virus （HBV） in renal tissues of patients with HBV-associated glomerulonephritis （HBV-GN）, and to analyze their roles in the diagnosis of HBV-GN. METHODS：Patients hospitalized in our department from January in 2003 to January in 2013 were retrospectively studied. A total of 49 patients with positive HBV surface antigen （HBsAg） serology, clinical manifestations of hematuria and/or proteinuria, and pathological diagnosis of glomerulonephritis, without systemic lupus erythematosus, anaphylactic purpura, diabetes or hepatitis C, were selected. PreS1/S2-Ag, HBV e antigen （HBeAg）, HBsAg and HBV core antigen （HBcAg） in the renal tissues were examined. Five cases of glomerular minimal-change disease （MCD） with negative HBsAg and 5 cases of non-glomerulonephritis with positive HBsAg served as controls. RESULTS：The positive rates of preS1/S2-Ag, HBeAg, HBsAg and HBcAg in the renal tissues from the 49 patients of glomerulonephritis with HBV infection were 32.7% （16 cases）, 38.8% （19 cases）, 14.3% （7 cases） and 46.9% （23 cases）, respectively. Total antigen positive rate was 70.2% （36 cases）. The expression of preS1/S2-Ag was located in the cytoplasm of renal tubular epithelial cells, glomerular epithelial cells, endothelial cells and mesangial cells, and positively correlated with the expression of HBcAg （r=0.459, P〈001）. The 4 antigens were not detected in the 5 cases of HBsAg-negative patients with glomerular MCD. In the 5 cases of HBsAg-positive patients with non-glomerulonephritis, there were 2 cases expressing HBeAg and 1 case expressing HBcAg, but no cases expressing preS1/S2-Ag or HBsAg. CONCLUSION：The expression of preS1/S2-Ag in renal tissues suggests that HBV may invade the cells of renal tissue. Combined detection of the 4 antigens could elevate the rate of diagnosis of HBV-GN.