乙型肝炎病毒相关性肾炎临床病理分析  

Clinicopathological Analysis on Hepatitis B Virus-Associated Glomerulonephritis in Children

作　　者：王洪涛[1] 周建华[1] 

机构地区：[1]华中科技大学同济医学院附属同济医院儿科,武汉430030

出　　处：《实用儿科临床杂志》2006年第11期685-686,共2页Journal of Applied Clinical Pediatrics

基　　金：国家自然科学基金项目资助(30472268)

摘　　要：目的 探讨儿童乙型肝炎病毒相关性肾炎（HBV—GN）的临床和病理特点。方法 对经肾活检确诊HBV—GN患儿73例的临床及病理特点进行分析。本组男66例，女7例。发病年龄1～14岁，平均6．5岁。占同期肾活检14．4％（73／508）。结果 临床表现为肾病综合征（NS）53例（72．6％）、肾炎综合征15例（20．5％）、蛋白尿和血尿5例（6．9％）；血清HBV感染标志物均阳性，其中大三阳55例（75％），小三阳14例（19．2％），HBsAg及抗HBc阳性2例，HBAg及HBeAg阳性、仅抗HBc阳性各1例。病理分型：膜性肾病（MN）69例（94．5％），系膜增生性肾炎（MsPGN）及膜增生性肾炎（MPGN）各2例（各2．7％），表现为NS者病理改变全部为MN，临床表现与MN病理分级间存在显著线性关联（χ^2=5．22P=0．022）。结论 儿童HBV—GN病理以MN为突出特征，临床表现以NS为主，临床表现与病理改变有一定关联。Objective To investigate the clinicopathological features of hepatitis B virus - associated glomerulonephritis（HBV- GN） in children. Methods Clinical and pathological features were analyzed and correlated in 73 cases with renal biopsy - confirmed HBV- GN. Sixty- six boys and 7 girls aged from 1 to 14 years old were included in this study,accounting for 14.4% in children undergoing renal biopsy in the same period. Results Nephmtic syndrome（NS） was the prodominant clinical manifestation（53/73,72.6% ）, followed by glomerulonephritis（ 15/73,20.5 % ） and hematuria with pmteinuria（5/73,6.9 % ）. Serologic markers of HBV were found in all cases. Among them, 55 cases （75 % ） were positive for hepatitis B surface antigen（HBsAg）, hepatitis B e antigen（HBeAg） and anti-hepatitis B core（anti- HBc）, 14 cases （19.2%）positive for HBsAg, anti HBe and anti HBc, 2 cases positive for HBsAg and anti HBc, 1 child positive for HBsAg and HBeAg,and another only positive for anti - HBc. The most common pathological type of HBV GN was membranous nephropathy （MN）, which was found in 69 cases （94.5%）, followed by membranopmliferative glomerulonephritis （MPGN） and mesangial proliferative glomerulonephritis（MsPGN） ,2 cases （2.7%）, respectively. All cases with NS presented themselves with MN. The pathological grades were significantly correlated with clinical manifestations through double trend analysis（x^2 = 5.22 P = 0. 022）. Conclusions MN is predominant in childhood HBV - GN, which mainly presented with NS. Their clinical patterns are somewhat correlated with pathological grades.

关 键 词：乙型肝炎病毒相关性肾炎 病理学 临床 儿童 

分 类 号：R726.91[医药卫生—儿科]