儿童乙型肝炎病毒相关性肾炎74例临床病理分析  

Analysis of Clinicopathological Features of Hepatitis B Virus Associated Glomerulonephritis in 74 Children

作　　者：刘志莹[1] 胡宝金[1] 邹音[2] 傅睿[1] 刘洪[1] 

机构地区：[1]江西省儿童医院肾内科,南昌330006 [2]江西省儿童医院病理科,南昌330006

出　　处：《实用儿科临床杂志》2008年第17期1344-1345,1356,共3页Journal of Applied Clinical Pediatrics

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。方法收集经肾活检确诊为HBV-GN的74例患儿入院时临床表现(水肿、血压)及实验室检查结果(尿常规、24h尿蛋白定量、乙肝5项、血清清蛋白、血HBV DNA等),并对其肾组织进行光镜(常规染色及特殊染色)及免疫组织化学检查(IgG、IgA、IgM、C3c、C4c、HBsAg、HBcAg)。根据血清HBV DNA水平不同将74例HBV-GN患儿分为高病毒载量组(HBV DNA>1.0×108copies/L)58例和低病毒载量组(HBV DNA<1.0×108copies/L)16例,并比较分析其临床病理特点。结果临床表现:肾病综合征(NS)52例(70.3%);血尿和蛋白尿13例(17.6%);单纯性蛋白尿6例(8.1%);单纯性血尿3例(4.1%)。病理分型:膜性肾病(MN)56例(75.7%);系膜增生性肾小球肾炎(MsPGN)12例(16.2%);膜增生性肾小球肾炎(MPGN)5例(6.6%);毛细血管内增生性肾小球肾炎(EnPGN)1例。高病毒载量组与低病毒载量组入院时血清清蛋白[(22.04±7.69)g/Lvs(31.95±5.83)g/L],C3[(0.759±0.252)g/Lvs(0.986±0.330)g/L]比较均有统计学差异(Pa<0.05)。高病毒载量组病理类型多样,而低病毒载量组相对单一,以MsPGN、MN为主。结论HBV-GN患儿学龄期多见,且男多于女,临床表现以NS为主,病理类型以MN多见,血清HBV DNA水平与HBV-GN病变密切相关。Objective To explore clinicopathological features of hepatitis B virus associated glomerulonephritis （HBV - GN） in children. Methods Clinicopathological features of 74 children with HBV - GN proved by renal biopsy were analyzed. The clinical manifestation （edema and blood pressure） and laboratory examination data （routine urianlysis,24 h urinary protein excretion,the marker of HBV infection, serum albumn and other） in present were recorded. Pathological types of renal tissue were analyzed under the light microscope and by immunohistochemical methods. Seventy - four children with HBV - GN were divided into the higher viral load group （ HBV DNA 〉 1.0 ×10^8 copies/L） and the lower viral load group （ HBV DNA 〈 1.0 ×10^8 copies/L） on the basis of the serum level of HBV DNA. The differences in clini- copathological features between 2 groups were studied. Results Nephrotic syndrome （NS） was the prominent clinical manifestation （52/74, 70.3 % ）, followed by hematuria with proteinuria （ 13/74,17.6% ） and proteinuria without hematuria （6/74,8.1% ）, hematuria without proteinuria was the rarest （ 3/74,4. 1% ）. The commonest pathological types of HBV - GN were membranous nephropathy （ MN ） （ 56/74, 75.7% ） , the second was mesangial proliferative glomerulonephritis （ MsPGN ） （ 12/74,16.2% ） , membranoproliferative glomerulonephritis （MPGN） was found in 5 cases（6.6% ）, only 1 child was endocapillary proliferative glomerulonephritis （EnPGN）. Clinical data in present showed a marked reduction in serum albumin[ （22.04 ±7.69） g/L vs （ 31.95 ± 5.83 ） g/L] and C3 [ （0. 759 ± 0. 252 ） g/L vs 0. 986 ± 0. 330 ） g/L] in children with the higher level of serum HBV DNA when compared with those with the lower level of serum HBV DNA（ Pa 〈 0. 05 ）. There were variety of pathological types in children with higher viral load, however, MN and MsPGN were mainly found in the lower viral load group. Conclusions HBV -GN in children usually happened to

关 键 词：乙型肝炎病毒相关性肾炎 病理 免疫组织化学 儿童 

分 类 号：R726.9[医药卫生—儿科]