HBV相关肾小球肾炎的研究进展

Research advances in hepatitis B virus-associated glomerulonephritis

慢性HBV感染人群数量庞大,HBV不仅损害肝脏,肾脏也是主要受累器官之一,HBV相关肾小球肾炎(HBV-GN)是由HBV感染引起的继发性肾小球肾炎,是HBV感染最常见的肝外并发症之一。HBV-GN多见于儿童及中青年人,男性多见,临床上以不同程度蛋白尿为主要表现,可伴有血尿和高血压,最常见病理类型为膜性肾病,其次为系膜增生性肾小球肾炎和IgA肾病。HBV-GN起病隐匿,缺乏特征性的症状及病理学表现,易与各种肾小球肾炎混淆,导致漏诊误诊。HBV-GN发病机制复杂,涉及免疫紊乱、病毒直接损伤、遗传等诸多环节,其中免疫复合物沉积学说已得到广泛认可。近年来关于HBV-GN发病机制、诊断及治疗方面的研究取得了一些重要进展。本文将对此进行综述,希望为临床诊治提供参考。

There is are large number of patients with chronic hepatitis B virus(HBV) infection. HBV not only damages the liver, but also involves the kidney. Hepatitis B virus-associated glomerulonephritis(HBV-GN) is secondary glomerulonephritis caused by HBV infection, and it is one of the most common extrahepatic complications of HBV infection. HBV-GN is mainly observed in children and young and middle-aged adults, with varying degrees of proteinuria as the main clinical manifestation, and it may be accompanied by hematuria and hypertension. Membranous nephropathy is the most common pathological type, followed by membrano-proliferative glomerulonephritis and IgA nephropathy. HBV-GN has an insidious onset and lacks characteristic symptoms and pathological manifestations, and thus it may be easily confused with various types of glomerulonephritis, which may lead to missed diagnosis and misdiagnosis. HBV-GN has a complex pathogenesis involving various links such as immune disorders, direct viral damage, and genetics, among which the theory of immune complex deposition has been widely recognized. In recent years, some important advances have been made in the research on the pathogenesis, diagnosis, and treatment of HBV-GN. This article summarizes the above issues, so as to provide a reference for clinical diagnosis and treatment.