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乙型肝炎病毒相关性膜性肾病患儿足细胞缺失的研究 被引量:15
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作者 张瑜 周建华 王洪涛 《中华儿科杂志》 CAS CSCD 北大核心 2007年第5期344-348,共5页
目的观察乙型肝炎病毒相关性膜性肾病(HBV-MN)患儿肾小球足细胞数量的变化及意义。方法以 Wilms 瘤蛋白1(WT1)为足细胞核的特征性标记,通过免疫组织化学方法对19例经肾穿刺活检确诊为 HBV-MN 患儿及8例同期肾活检诊断为薄基底膜病(TBMD... 目的观察乙型肝炎病毒相关性膜性肾病(HBV-MN)患儿肾小球足细胞数量的变化及意义。方法以 Wilms 瘤蛋白1(WT1)为足细胞核的特征性标记,通过免疫组织化学方法对19例经肾穿刺活检确诊为 HBV-MN 患儿及8例同期肾活检诊断为薄基底膜病(TBMD)的患儿(对照组)肾脏病理切片的足细胞进行特异性染色,采用 Weibel-Gomez 点计数方法测定单位肾小球足细胞绝对数目(Npodo)、足细胞相对密度(Nv)及单个肾小球毛细血管簇体积(V),比较两组间差异,并分析其与血清免疫学检查、蛋白尿程度及肾组织病理改变等指标间的关系。结果①19例 HBV-MN 患儿的超微病理结果均显示存在不同程度的足突融合,3例有足突微绒毛化,4例出现足细胞肿胀,1例足细胞空泡变性,2例可见足细胞崩解;②HBV-MN 患儿 Npodo 及 Nv 均较对照组显著下降(P<0.01);③ Npodo 的减少与肾小球中 HBsAg 的沉积强度相关,HBsAg 免疫荧光强度≥(++)患儿的平均 Npodo 明显低于荧光强度<(++)者(p<0.01);但 Npodo 及 Nv 的下降均与肾脏病变病理分期无显著相关性;④Nv 减少与蛋白尿程度相关,24 h尿蛋白定量<2 g患儿的 Nv 明显高于>2g 者(P<0.05);⑤肾小球足细胞数量与血清补体 C_3,水平呈正相关(r=0.548,P=0.028),而与血清白蛋白水平无显著相关性(r=-0.037,P=0.891)。结论 HBV-MN 患儿均存在不同程度的足细胞损伤、缺失,Npodo 减少可能在 HBV-MN 的发病中起重要作用。 展开更多
关键词 肝炎病毒 乙型肾小球肾炎 膜性 上皮细胞
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Meta-analysis of combined therapy for adult hepatitis B virus-associated glomerulonephritis 被引量:34
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作者 Xiao-Yong Zheng Ri-Bao Wei +2 位作者 Li Tang Ping Li Xiao-Dong Zheng 《World Journal of Gastroenterology》 SCIE CAS CSCD 2012年第8期821-832,共12页
AIM: To investigate the efficacy and safety of combined antiviral and immunosuppressant therapy in adult hepatitis B virus-associated glomerulonephritis (HBVGN) patients. METHODS: A computerized literature search was ... AIM: To investigate the efficacy and safety of combined antiviral and immunosuppressant therapy in adult hepatitis B virus-associated glomerulonephritis (HBVGN) patients. METHODS: A computerized literature search was carried out in the PubMed database, Embase, the Cochrane Library, Chinese BioMedical Literature on disc, Chinese Medical Current Contents, Chinese National Knowledge Infrastructure, Wanfang and VIP (Chinese Technological Journal of Database) to collect articles between June 1980 and December 2010 on therapy with immunosuppressants, e.g., glucorticosteroids, mycophenolate mofetil and leflunomide, combined with antivirals, e.g., interferon, lamivudine, entecavir and adefovir dipivoxil, in adult HBV-GN patients. The primary outcomes were remission of proteinuria, clearanceof HBV e-antigen, and elevation of serum albumin. The secondary outcomes were blood levels of alanine aminotransferase, serum creatinine, and HBV-DNA titer. Meta-analysis was performed using Review Manager 5.1. Fixed or random effect models were employed to combine the results after a heterogeneity test. The effects of the combined therapy were analyzed for different doses of glucorticosteroid and different types of HBV-GN. RESULTS: Twelve clinical trials with 317 patients were included. A significantly higher incidence of HBV-GN was found in male patients (relative risk = 2.40, 95% CI: 1.98-2.93). Combined therapy reduced the proteinuria significantly with a mean difference of 4.19 (95% CI: 3.86-4.53) and increased the serum albumin concentration significantly with a mean difference of -11.95 (95% CI: -12.97-10.93) without significant alterations of liver function (mean difference: 4.62, 95% CI: -2.55-11.79) and renal function (mean difference: 10.29, 95% CI: 0.14-20.45). No signif icant activation of HBV-DNA replication occurred (mean difference: 0.12, 95% CI: -0.37-0.62). There was no significant difference between the high dose glucorticosteroid group and the low dose glucorticosteroid group in terms of proteinuria remission (P = 0.76) and between different pathological types of HBV-GN [membranous glomerulonephritis (MN) vs mesangial proliferative glomerulonephritis, P = 0.68; MN vs membranoproliferative glomerulonephritis, P = 0.27]. CONCLUSION: Combined antiviral and immunosuppressant therapy can improve the proteinuria in HBVGN patients without altering HBV replication or damaging liver and renal functions. 展开更多
关键词 META-ANALYSIS Hepatitis B virus-associatedglomerulonephritis GLUCOCORTICOIDS IMMUNOSUPPRESSANT Antiviral drug
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