198例特发性膜性肾病合并HBV感染病例临床及病理特征

Clinical and pathological characteristics of 198 idiopathic membranous nephropathy patients complicated with HBV infection

目的探讨特发性膜性肾病(idiopathic membranous nephropathy, IMN)合并乙型肝炎病毒(hepatitis B virus, HBV)感染患者血生化、尿液检查临床特点及肾活检病理特征。方法抽取2007年11月-2019年2月成都医学院第二附属医院行肾活检患者1 232例临床资料,统计经肾活检及临床确诊为IMN、IMN合并HBV感染发生情况,比较IMN患者及IMN合并HBV感染患者的实验室检测指标水平与肾活检的病理特点。结果 1 232例肾活检患者中有198例IMN,IMN发生率为16.07%;198例IMN患者中有19例发生HBV感染,HBV感染率为9.60%;IMN合并HBV组患者IMN分期(Ⅱ、Ⅲ期占比)、血肌酐(SCr)、尿素氮、尿酸、谷丙转氨酶、谷草转氨酶、总胆固醇、三酰甘油、总胆红素、直接胆红素、低密度脂蛋白胆固醇(LDL-C)水平均高于IMN患者(P<0.05),而血清白蛋白、总蛋白、补体C3、补体C4、高密度脂蛋白胆固醇(HDL-C)水平均低于IMN患者(P<0.05);尿液检查结果显示,IMN合并HBV组患者24 h尿蛋白定量(24 hUp)高于IMN组患者(P<0.05),而肾小球滤过率(GFR)、尿渗透压均低于IMN组患者(P<0.05);肾病组织病理结果显示,IMN合并HBV组患者中假双轨、节段硬化比率均明显高于IMN组患者(P<0.05),内皮下沉积率高于IMN组(P<0.05)。结论 IMN合并HBV患者同时表现出肝、肾功能损伤,并且肾功能损伤程度高于单纯IMN患者。

OBJECTIVE To explore the biochemical indexes,clinical characteristics of urine test and pathological features of renal biopsy of the idiopathic membranous nephropathy(IMN)patients complicated with hepatitis B virus(HBV)infection.METHODS The clinical data were extracted from 1232 patients who underwent renal biopsy in the Second Affiliated Hospital of Chengdu Medical College from Nov 2007 to Feb 2019,the incidence of HBV infection of the patients who were clinically diagnosed with IMN through renal biopsy was statistically analyzed,and the laboratory test indexes and pathological features of renal biopsy were observed and compared between the IMN patients and the IMN patients complicated with HBV infection.RESULTS Of the 1232 patients who underwent the renal biopsy,198 had IMN,with the incidence rate 16.07%.Among the 198 IMN patients,19 had HBV infection,with the incidence rate 9.60%.The proportions of the patients with stageⅡorⅢIMN and levels of serum creatinine(SCr),blood urea nitrogen,uric acid,alanine aminotransferase,aspartate aminotransferase,total cholesterol,triacylglycerol,total bilirubin,direct bilirubin and low density lipoprotein cholesterol(LDL-C)of the IMN patients complicated with HBV infection were significantly higher than those of the IMN patients(P<0.05),while the levels of serum albumin,total protein,complement C3,complement C4 and high density lipoprotein cholesterol(HDL-C)of the IMN patients complicated with HBV infection were significantly lower than those of the IMN patients(P<0.05).The result of urine test showed that the 24-hour urine protein quantitation(24 hUp)of the IMN patients complicated with HBV infection was significantly higher than that of the IMN patients(P<0.05),while the glomerular filtration rate(eGFR)and urine osmolality of the IMN patients complicated with HBV infection were significantly lower than those of the IMN patients(P<0.05).Histopathological results of kidney disease showed that the proportions of pseudo dual-rail and segmental sclerosis were significantly higher in the IMN-HBV group than in the IMN group(P<0.05),and the subcutaneous deposition rate was significantly higher in the IMN-HBV group than in the IMN group(P<0.05).CONCLUSION The IMN patients complicated with HBV infection may present with damage of liver and kidney function,and the degree of the damage of the IMN patients complicated with HBV infection is higher than that of the patients with simple IMN.