X基因突变对乙型肝炎病毒相关性肾炎患者尿蛋白及肾脏病理的影响

Effects of X gene mutation on proteinuria and renal pathological changes in patients with hepatitis B virus associated glomerulonephritis

目的探讨x基因突变对HBV相关性肾炎（HBV-GN）尿蛋白量及肾脏病理的影响。方法通过肾脏病理活检确诊54例HBV-GN患者，通过对患者血清HBVX基因序列分析，找到突变位点，探讨突变对尿蛋白及肾脏病理变化的影响；抗病毒治疗后，分析患者预后变化。结果54例HBV—GN患者中，42例感染的HBV存在X基因位点突变；42例HBV突变株感染患者24h尿蛋白量水平为3．51（1125～5．65）g／d，显著高于未突变患者（在0．02，P〈0．05）。38例伴有x基因突变膜性肾病（MN）患者肾脏病理损害较7例未突变MN患者明显加重，差别具有统计学意义（Spearman=0．3826，P〈0．01）。经抗病毒治疗后X基因突变组患者临床缓解率较低。结论HBV的X基因突变广泛存在于HBV—GN患者中，突变株感染导致患者尿蛋白及肾脏病理损害加重，同时突变病例临床缓解率降低，提示X基因突变是HBV—GN发生及进展的重要原因。

Objective To investigate the effects of HBV X gene mutation on proteinuria and renal pathological changes in patients with HBV associated glomerulonephritis （HBV-GN）. Methods HBV-GN patients were diagnosed by renal biopsy. X gene sequences were analyzed to find mutation sites, so as to explore their effects on urine protein and renal pathological change. The prognosis after antiviral therapy was also analyzed. Results X gene mutation was found in 42 cases among 54 HBV-GN patients. The 24-hour urine protein excretion in 42 cases with X gene mutation was 3.51 （1.25-5.65）g/d,which was higher than that in cases without mutation （Z=0.02,P〈 0.05）. A total of 38 membranous nephropathy （MN） cases with X gene mutation suffering more serious renal pathological damage than 7 MN ones without X gene mutation,and the difference had statistical significance （Spearman=0.3826,P〈0.01）. The clinical remission rate was lower in patients with X gene mutation after antiviral therapy. Conclusions HBV X gene mutations commonly exist in HBV-GN patients,which can cause proteinuria, renal pathological damage and poor prognosis significantly. X gene is a key factor resulting in HBV-GN development and progression.