乙型肝炎病毒在不同ALT状态下对乙型肝炎相关性肾小球肾炎的影响

The effects of hepatitis B virus on hepatitis B virus associated glomerulone nephritis under different ALT stages

目的:探讨不同丙氨酸氨基转移酶(alanine aminetransferase,ALT)状态下不同载量的乙型肝炎病毒(hepatitis B virus,HBV)对乙型肝炎相关性肾小球肾炎(hepatitis B virus-associated glomerulone nephritis,HBV-GN)的影响。方法:回顾性分析兰州大学第一医院确诊为HBV-GN的患者646例,化验指标包括:尿N-乙酰-β-D-葡萄糖苷酶(N-acetyl-β-D-glucosidase,NAG)、尿β2微球蛋白(β2 microglobulin,β2M),肝功能指标ALT,肾功能指标肌酐、血尿素氮、肾小球滤过率(glomerular filtration rate,GFR)。荧光定量PCR法测量HBV载量。对646例HBV-GN病理类型分布进行统计,分析不同ALT状态下HBV载量对HBVGN肾脏功能及肾脏病分期的影响。结果:HBV-GN以弥漫性膜增生性肾病为主,约占60.7%,其次为毛细血管内增生性肾小球肾炎,约占26.2%,局灶节段肾小球硬化和系膜增生性病变较为少见。在ALT正常组HBV对肾脏功能指标无明显影响。而在ALT异常组中HBV对肾脏功能指标有影响,特别以ALT≥2倍正常值上限(upper limit of normal,ULN)组中为甚。随着病毒载量的增高,血肌酐、血尿素氮、24 h尿蛋白定量、尿NAG、尿β2M明显增高,而GFR明显下降,差异均有统计学意义(P <0.05)。在ALT正常组和ALT<2ULN组中,HBV对慢性肾脏病分期无明显影响;而在ALT≥2ULN组中,随着病毒载量的增高,慢性肾脏病分期有加重倾向。结论:在不同ALT状态下,HBV对HBV-GN的影响是不同的,综合分析这一现象,有助于临床更好地诊断和治疗该疾病。

Objective:To investigate the effect of hepatitis B virus(HBV)on the HBV associated glomerulone nephritis(HBV-GN) under different alanine aminetransferase(ALT)levels. Methods:A total of 646 HBV-GN patients in the First Hospital of Lanzhou University were analyzed retrospectively. All the selected patients have complete medical records and have undergone renal histopathology. Laboratory tests include:N-acetyl-β-D-glucosidase(NAG),β2 microglobulin(β2M),liver function parameters ALT,renal function parameters creatinine(Cr),blood urea nitrogen(BUN),glomerular filtration rate(GFR). The HBV loads were measured by quantitative PCR. The distribution of pathological types of 646 HBV-GN was investigated,and the effects of HBV loads on renal function of the HBV-GN and stage of chronic kidney disease under different ALT levels were analyzed. Results:HBV-GN is mainly diffuse membrane hypertrophic nephropathy,accounting for about 60.7%,followed by capillary hyperplastic glomerulonephritis,accounting for about 26.2%,the focal segment glomerulonephritis and mesenteric hyperplastic lesions are rare. In the ALT normal HBV-GN patients group,the effect of HBV on the renal function is minor,while in the ALT abnormal group,the effect is significant,and this difference is obvious in the ALT≥2 ULN(upper limit of normal). With viral load increasing,blood Cr,BUN,24 h urine protein quantification,urine NAG,β2M increased,while GFR decreased(P < 0.05). In the normal ALT group and the ALT<2 ULN group,the viral load has no relationship with chronic kidney disease staging,but in the ALT≥2 ULN group the viral load had a significant relationship with the chronic kidney disease staging. Conclusion:In different ALT condition,the effect of HBV on HBV-GN is different. A comprehensive analysis of this phenomenon is conducive to the clinical diagnosis and treatment of this disease.