老年乙型肝炎病毒相关性肾炎临床与病理特点

Clinical and Pathological Characteristics of Hepatitis B Virus-related Nephritis in the Elderly

目的探讨老年乙型肝炎病毒相关性肾炎(HBV-GN)的临床、病理特点,为老年HBV-GN的治疗提供理论依据。方法方便选取33例于2015年1月—2018年7月在联勤保障部队第九〇〇医院经肾穿刺活检明确诊断HBV-GN的老年患者的一般资料、临床表现及肾脏病理进行回顾性分析及相关统计学比较。结果①老年HBV-GN患者中,男女比为3.7:1,平均年龄(65.9±3.1)岁;②老年HBV-GN临床表现以肾病综合征最多见占54.5%;合并水肿者占66.7%、贫血者占24.2%、高血压病者占57.6%、肾功能异常者占33.3%,进入ESRD者占18.2%;③HBV-MPGN与HBV-FSGS的合并症较多,且进入ESRD的患者均为该两种病理类型;④老年HBV-GN病理类型以MN最多见占33.3%,其他依次为MPGN及MsPGN,三者总和占84.8%;⑤肾组织中可见多种免疫物质同时沉积的现象(“满堂亮”)占21.2%。且HBV抗原在肾组织中均可被检出,HBsAg检出率为90.9%,HBcAg检出率为54.5%,两者同时阳性占45.5%;⑥“大三阳”组14例(42.4%)与“小三阳”组19例(57.6%)在HBV-DNA有无复制及肾组织中乙肝抗原沉积类别情况比较中差异均无统计学意义(P>0.05);⑦各种病理类型均有不同程度的系膜细胞、系膜基质增生,大多伴基底膜增厚及足细胞病变,并可见免疫复合物多部位沉积,部分可有毛细血管内皮细胞增生及新月体形成,并伴有一定程度肾小球硬化。结论老年HBV-GN以肾病综合征为主要临床表现,病理类型以MN为主,且合并症较多,预后多不良。

Objective To investigate the clinical and pathological characteristics of hepatitis B virus-associated nephritis(HBV-GN)in the elderly,and to provide a theoretical basis for the treatment of HBV-GN in the elderly.Methods The general data,clinical manifestations,and renal pathology of convenient selection 33 elderly patients who were diagnosed with HBV-GN by renal biopsy at the 900th Hospital of the Joint Logistics Service Force from January 2015 to July 2018 were retrospectively analyzed.Related statistical comparisons.Results 1.In elderly patients with HBV-GN,the male to female ratio was 3.7:1,and the average age was(65.9±3.1)years;2.The clinical manifestations of elderly HBV-GN were nephrotic syndrome,which accounted for 54.5%;patients with edema accounted for 66.7%,anemia accounted for 24.2%,hypertension patients accounted for 57.6%,renal dysfunction accounted for 33.3%,ESRD accounted for 18.2%;3.HBV-MPGN and HBV-FSGS have more comorbidities,and patients entering ESRD are the two most common pathological type;4.HBV-GN in the elderly is MN,which accounts for 33.3%,followed by MPGN and MsPGN,and the sum of the three accounts for 84.8%;5.The phenomenon of simultaneous deposition of multiple immune substances can be seen in kidney tissue("Mantangliang")accounted for 21.2%.And HBV antigen can be detected in kidney tissues,the detection rate of HBsAg was 90.9%,the detection rate of HBcAg was 54.5%,and both were positive at the same time accounting for 45.5%;6.14 cases(42.4%)in the"big three positive"group had no statistically significant difference between the 19 cases(57.6%)of the"Xiaosanyang"group in the presence or absence of HBV-DNA replication and the type of hepatitis B antigen deposition in the kidney tissue(P>0.05);⑦Different pathological types proliferation of mesangial cells and mesangial matrix,mostly accompanied by thickening of basement membrane and podocyte disease,and deposition of immune complexes at multiple sites,some may have proliferation of capillary endothelial cells and formation of crescents,accompanied by a certain degree of glomerular sclerosis.Conclusion Elderly HBV-GN has nephrotic syndrome as the main clinical manifestation,the main pathological type is MN,and there are many complications and poor prognosis.