成人与小儿乙型肝炎病毒相关性肾炎的比较  

Hepatitis B virus associated nephritis in adults and children

作　　者：方利君[1] 盛芳芸[1] 郭怡清[1] 吴兆龙[1] 陆福明[1] 张月娥[1] 郭慕依[1] 张秀荣[1] 

机构地区：[1]上海医科大学儿科医院,上海医科大学中山医院,上海医科大学华山医院,上海医科大学病理教研室

出　　处：《中华传染病杂志》1996年第2期92-96,共5页Chinese Journal of Infectious Diseases

摘　　要：为正确认识成人与小儿乙型肝炎病毒相关性肾炎（ＨＢＶ－ＧＮ）的特点。对上海医科大学各附属医院中２１例成人及２２例小儿的临床表现，病理类型，治疗反应及转归等不同之处进行了比较，同时，用微量酶联免疫法检测ＨＢＶ标志，肾组织的病理形态，免疫组化法检测肾组织ＨＢＶ抗原，Ｓｏｕｔｈｅｒｎ印迹杂交检测ＨＢＶＤＮＡ。结果发现成人组病程长于小儿组，提示成人肾脏受损日期较长；临床表现成人呈肾病１１／２１例，慢性肾炎９／２１例，小儿则以肾病为主２１／２２例；病理类型二组均以膜性肾炎占首位，但小儿组为１７／２２例高于成人组１０／２１例。二组共有３４例肾病及慢性肾炎患者对类固醇激素治疗不敏感。有４例患儿接受人α＿１－干扰素治疗，随访１～３年，２例血清ＨＢＶ抗原转阴，另２例尿蛋白消失，上述结果提示：人α＿１－干扰素为治疗小儿ＨＢＶ－ＧＮ开辟了一新的途径。To further investigate HBV associated nephritis(HBV-GN)in adults and children,we compared its clinical manifestations,pathological classifications,response to treatment and prog-nosis between these two groups.43 HBV-GN cases from hospitals affiliated to Shanghai Medical U-niversity were analyzed.The main aspects included their clinical diagnosis,sero-immunological dataof HBV infection assayed by micro-enzyme coupling technique,renal pathological findings immuno-chemical survey of HBV antigens in renal tissues and HBV DNA by Southern blot hybridization ofDNA isolated from renal punctures.It was shown that the clinical course was longer in adults thanthat in children,implicating the longer course of renal impairment in adults.11 of 21 adult patientswere manifested by nephrotic syndrome and 9 by chronic nephritis;while in children 21 of 22 pa-tients were presented by nephrotic syndrome.Moreover,membranous nephritis was the dominantpathological lesion found in both groups,though the rate was higher in children(17/22)than thatin adults(10/21).As with treatment,patients with nephrotic syndrome and chronic nephritis fromthe two groups were insensitive to glucocorticoid hormones.4 children were treated with rh IFN α1and were followed up for 1-3 years.The serum HBV antigens in two children were converted to neg-ative and proteinuria disappeared in the other 2 cases.This implied that rh IFN α1 might be another way to treat HBV-GN in children.

关 键 词：乙型肝炎病毒 肾炎 成人 儿童 

分 类 号：R692.3[医药卫生—泌尿科学] R726.923[医药卫生—外科学]