儿童乙型肝炎病毒相关性肾炎临床病理分析

Analysis of clinicopathological features of hepatitis B-associated glomerulonephritis in children

目的 探讨儿童乙型肝炎病毒相关性肾小球肾炎 (HBV GN)临床及病理特点。方法 分析 35例HBV GN的临床表现及肾活检光镜、免疫荧光和电镜特点。结果 35例HBV GN临床表现以肾病综合征 (NS)为主 (32 / 35 ,91.4 % ) ;肾小球肾炎 3/ 35 (8.6 % )。病理类型以膜性肾病 (MN)最多见 (33/ 35 ,94 .3% ) ;其次系膜增生性肾炎 (MsPGN ,2 / 35 ,5 .7% )。免疫荧光检查呈多种免疫复合物沉积。电镜观察HBV MN易见电子致密物系膜沉积 ,2例肾小球基底膜内观察到病毒样颗粒。结论 儿童HBV GN临床常表现主要为NS ,病理特征以MN为主 ,诊断不必强调HBsAg、HBcAg在肾组织上沉积 。

Objective To investigate the clinicopathological features of hepatitis B virus-associated glomerulonephritis (HBV -GN) in children.Methods Thirty-five HBV-GN cases were confirmed by renal biopsy. Clinical and pathological features of these cases were analyzed under the light microscope,immunofluorescence and electron microscope.Results Nephrotic syndrome was the mostly encountered clinical manifestations in 35 cases, the rate of which was 91.4 %(32/35),the other was glomerulonephritis, the rate of which was 8.6 %(3/35),the most common pathological types of HBV-GN was membranous nephropathy(MN), with the rate of 94.3 %(33/35).The second was mesangial proliferative glomerulonephritis (MsPGN), with the rate of 5.7 %(2/35). Immunofluorescence microscope(IF) result showed multiple immune compound deposit; under electron microscope(EM), mesangial dense deposits could easily be found in hepatitis B virus-associated membranous nephropathy(HBV -MN) cases;2 cases of HBV-MN virus-like granules were found in the basement membrane of glomeruli.Conclusions Clinical features of children with HBV-GN are characterized by nephrotic syndrome. Pathologically ,it belongs mainly to membranous nephropathy. Emphasis on the deposit of markers of HBsAg and HBcAg in renal tissue is not needed for the diagnosis of children's HBV-MN, which is supported by the pathologic features that HBV may cause renal lesion by means of various mechanisms.