B/C基因型的乙型肝炎病毒在不同ALT状态下对乙型肝炎相关性肾炎的差异性影响

Differential Effects of B/C Genotype Hepatitis B Virus on Hepatitis B Associated Nephritis in Different ALT States

【目的】探讨不同ALT状态下B/C基因型的乙型肝炎病毒对乙型肝炎相关性肾小球肾炎的差异性影响。【方法】回顾性分析兰州大学第一医院确诊为乙型肝炎相关性肾小球肾炎的患者558例,所选病人均病历完整,均接受过肾组织病理学检查,化验指标包括:丙氨酸氨基转移酶、肌酐、尿β2微球蛋白、尿N-乙酰-β-D-葡萄糖苷酶、血尿素氮、肾小球滤过率、乙型肝炎病毒载量及基因型。【结果】B型C型基因型的乙肝相关性肾小球肾炎均以弥漫性膜增生性肾病为主(57.9%vs.54.4%),其次为毛细血管内增生性肾小球肾炎(25.3%vs.28.0%),局灶节段肾小球硬化(9.7%vs.9.0%)和系膜增生性病变(7.1%vs.8.6%)较为少见。在ALT正常组B/C基因型的乙型肝炎病毒对肾脏功能影响差异无统计学意义(P>0.05)。而在ALT≥2倍上限组中,C型基因型较B型基因型的乙型肝炎相关性肾小球肾炎患者中,血肌酐、血尿素氮、24h尿蛋白定量、尿NAG、尿β2M明显增高(P<0.05),而肾小球滤过率GFR明显下降(P<0.05),差异有统计学意义。在ALT正常组中B/C型的乙型肝炎病毒对慢性肾脏病分期差异无统计学意义(P>0.05)。而在ALT≥2倍上限组中,C型基因型较B型基因型的乙型肝炎相关性肾小球患者中,慢性肾脏病分期有趋于加重的倾向(χ^2=11.144,P=0.025)。【结论】对比分析不同基因型的乙型肝炎病毒对乙型肝炎相关性肾炎的差异性影响,将有助于帮助临床诊治乙型肝炎相关性肾炎。

【Objective】To investigate the differential effects of B/C genotype hepatitis B virus on hepatitis B associated nephritis in different ALT states.【Methods】We retrospectively analysized 558 patients with hepatitis B virus associated glomerulonephritis in The First Hospital of Lanzhou University. All the selected patients have complete medical records and had undergone renal histopathology. Laboratory tests included:ALT,NAG,Cr,GFR,hepatitis B virus load and genotypes.【Results】We found genotype B and genotype C hepatitis B virus associated glomerulone nephritis was mainly diffuse membrane hypertrophic nephropathy(57.9% vs. 54.4%), followed by capillary hyperplastic glomerulonephritis (25.3% vs. 28.0%),and focal segment glomerulonephritis(9.7% vs. 9.0%). Mesenteric hyperplastic lesions(7.1% vs. 8.6%)were rare. In the ALT normal group,B/C genotype hepatitis B virus had no differential effect on renal function (P > 0.05). In the ALT ≥ double upper limit of normal group ,blood creatinine,blood urea nitrogen,24 h urine protein quantification,urine N-acetyl-β-D-glucosidase,and urine β2 microglobulin significantly increased(P < 0.05).Glomerular filtration rate significantly decreased(P < 0.05) in the genotype C hepatitis B-related glomerulonephritis group compared with the genotype B group. In the ALT normal group genotype B/C hepatitis B virus had no differential effect on the stage of chronic kidney disease(P > 0.05). But in the ALT ≥ double upper limit of normal group,compared with genotype B,chronic kidney disease staging tends to be worse in the genotype C hepatitis B associated nephritis(χ^2 = 11.144,P = 0.025).【Conclusion】Comparative analysis of the differential effects of different genotype hepatitis B virus on hepatitis B-associated nephritis will help to diagnose and treat hepatitis B-associated nephritis.