抗乙肝病毒联合免疫抑制剂治疗HBsAg阳性、HBV-DNA复制的乙肝相关性膜性肾病  

Antivirus Combined with Immunosuppressive Therapy Hepatitis B Virus-associated Membranous Glomerulonephritis Those with HBsAg Positive and HBV Replication

作　　者：方一卿[1] 吴平[1] 鲁盈[1] 毛俐婵[1] 胡云琴[1] 汤绚丽[1] 

机构地区：[1]浙江中医药大学附属广兴医院(杭州市中医院)肾内科,杭州310007

出　　处：《中国中西医结合肾病杂志》2009年第9期784-787,共4页Chinese Journal of Integrated Traditional and Western Nephrology

摘　　要：目的:探讨抗乙肝病毒联合免疫抑制剂方案治疗HBsAg阳性、HBV-DNA复制的乙肝相关性膜性肾病(HBV-MN)的疗效和安全性。方法:回顾性收集经肾活检确诊并住院治疗和随访的20例HBV-MN成人患者,分成乙肝活动组(10例)和无乙肝活动组(10例),血清HBsAg阳性、HBV-DNA>1000拷贝/ml的HBV-MN患者称乙肝活动组,接受抗乙肝病毒联合免疫抑制剂加ACEI和/或ARB治疗;血清HBsAg阴性、HBV-DNA<1000拷贝/ml的HBV-MN患者称无乙肝活动组,仅接受免疫抑制剂加ACEI/ARB治疗,对两组患者进行临床表现、病理特征、治疗缓解率、副反应发生率的回顾性对比分析。结果:(1)乙肝活动组伴有高血压3例(30%),无乙肝活动组伴有高血压6例(60%),两组患者均有浮肿和血尿;谷丙转氨酶(ALT)、谷草转氨酶(AST)、血白蛋白(Alb)、24h尿蛋白定量、血肌酐(Scr)和肾小球滤过率(GFR)两组之间差异均无统计学意义(P>0.05)。(2)两组病例光镜和电镜下表现均无差异;肾组织免疫荧光显示免疫球蛋白和补体沉积均在3种及以上,两组间C1q和纤维蛋白原沉积比例差异无统计学意义。(3)乙肝活动组完全缓解率60%,总缓解率100%,平均缓解时间13.7个月;无乙肝活动组完全缓解率70%,总缓解率90%,平均缓解时间13.2个月。(4)治疗副反应:乙肝活动组1例出现血HBV-DNA升高,1例出现肝酶升高;无乙肝活动组2例出现肝酶升高,减药物剂量后肝酶恢复正常,两组均未发现严重不良反应。结论:HBV-MN患者的肾脏损害程度并不取决于血中乙肝病毒的活跃程度;HBV-MN治疗应遵循个体化原则,若血中乙肝病毒复制者,在严密监测情况下,抗乙肝病毒联合激素或/和免疫抑制剂治疗可能是一种对疾病有益的尝试。Objective：To study the effect and security of Antivirus combined with Immunosuppressive therapy for Hepatitis B virus- associated membranous glomerulonephritis （HBV- MN）those with HBsAg positive and HBV replication. Methods： collected 20 adult in - patients with HBV - MN treated and followed - up in our hospital. They were divided into 2 groups. One group was active hepatitis group （ 10eases）, while the other group was inactive hepatitis group（ 10cases）. The first group is those whose positive and HBV - DNA〉 1 000 copies/ml, and they were treated with Antiviru combined with Immunosuppressive therapy and A- CEI, and or ARB. The second group is those whose HBsAg negative and HBV - DNA〈 1 000 copies/ml, and they were treated with immunosuppressive therapy and ACEI, and or ARB. Analyze retrospectively clinical manifestations and pathologic features, remission rate and the incidence rate of side reaction. Results： （1）hypertension was presented in 3 cases in active hepatitis group（30 % ）, 6 cases in inactive hepatitis group（60% ）, edema and haematuria were occurred in both groups, there was no significant difference between the two groups in glutamic pymvic transaminase, （ALT）, glutamic oxaloacetic transaminase, （AST）, plasma- albumin（Alb）, urinary protein of 24 hours and serum creatinine（P〉0.05）. （2）There was no significant difference between the two groups in light microscope and electron microscope, immunofluorescence showed more than 3 kinds of immunoglobulin deposit, and these was no significant difference of Clq and fibrinogen. （3）The rate of complete remission was 100% in active hepatitis group, 70% in active hepatitis group,the average time to remission was 13.7 months in active hepatitis group ,and 13.2months in inactive hepatitis group. （4） Side reaction of treatment：HBV-DNA icreased in lcase of active hepatitis group,and lcase ALTincreased and 2cases ALT increased in inactive hepatitis group and recoved after drug withdrawal. There was no Seri

关 键 词：乙肝病毒相关性肾炎 肾脏组织 HBsAg HBCAG 治疗 

分 类 号：R512.62[医药卫生—内科学] R692[医药卫生—临床医学]