血清乙型肝炎病毒DNA载量对乙型肝炎相关性肾炎临床及病理表现的影响  

Influence of HBV DNA on the clinical manifestation and pathological changes of HBV-associated glomerulonephritis

作　　者：李平[1] 魏日胞[1] 汤力[1] 陈仆[1] 师锁柱[1] 尹忠[1] 陈香美[1] 

机构地区：[1]解放军总医院肾病科全军肾脏病研究所暨重点实验室,北京100853

出　　处：《解放军医学杂志》2009年第10期1181-1184,共4页Medical Journal of Chinese People's Liberation Army

基　　金：国家自然科学基金(30800521);全军"十一五"计划科研项目(06MA265)

摘　　要：目的研究血清乙型肝炎病毒(HBV DNA)载量对乙型肝炎病毒相关性肾炎(HBV-GN)的临床表现及肾脏病理的影响。方法根据HBV DNA复制程度将135例患者分为4组:病毒复制阴性组(n=52)、低度复制组(n=21)、中度复制组(n=20)、高度复制组(n=42)。收集患者血常规、血生化指标、免疫球蛋白、血清补体C3、C4;尿常规、24h尿蛋白定量,尿NAG酶等数据。用半定量积分法分析各组间临床指标与病理表现的差异。结果随着血清HBV DNA载量的增加,患者中肾病综合征比例增高,而慢性肾炎综合征比例下降(P<0.01)。随着血清HBV DNA载量的增加,患者尿蛋白定量升高(P<0.01),血浆白蛋白降低(P<0.05),血清C3、C4降低(P<0.05);膜性肾病患者肾小球损伤加重,IgA肾病的患者小管及间质损害加重。病毒复制阴性组乙肝标记物沉积以HbsAg为主,而中、低度复制组以HbcAg和HBsAg共同沉积为主,与阴性组比较差异有统计学意义(P<0.01)。随着血清HBV DNA的增加,肾脏C4沉积增加,与血清HBV DNA有一定相关性(r=0.343,P<0.01)。结论随着血清HBV DNA载量的增加,HBV-GN患者的临床及肾脏病理表现加重,相关结果可为HBV-GN患者的抗病毒治疗提供依据。Objective To investigate the correlation between the loading quantity of hepatitis B virus（HBV DNA） in serum and the clinical manifestation and pathological changes of Hepatitis B virus-associated glomerulonephritis（HBV-GN）.Methods One hundred and thirty-five patients were divided into 4 groups according to the content of HBV DNA in serum as undetected group（n=52）,low-replicated group（n=21）,mid-replicated group（n=20） and high-replicated group（n=42）.General data,blood routine,urine routine,blood biochemistry,immunoglobulins,complement C3 and C4,24h urinary protein excretion,urine NAG enzyme and the renal biopsy data of patients were collected.The differences in clinical manifestation and pathological changes among four groups were analyzed by semiquantitative method.Results As HBV DNA increased,the ratio of nephrotic syndrome became larger and that of chronic nephritic syndrome smaller（P〈0.01）.With the increase of the content of HBV DNA in serum,the urinary protein increased（P〈0.01）,the plasma albumin,C3 and C4 decreased（P〈0.05）,and the impairment of glomerulus in HBV-membranous nephropathy and of tubule interstitial in IgA nephropathy was aggravated.HbsAg was the main HBV marker deposition in undetected group,while deposition of both HbsAg and HbcAg was found in both low-and mid-replicated group,which was significantly different from that in undetected group（P〈0.01）.The deposition of C4 increased with the increase in HBV DNA,showing a positive correlation（r=0.343,P〈0.01）.Conclusions With the increase in the content of HBV DNA in serum,there is an aggravation of the clinical manifestation and pathological changes in HBV-GN patients,and it may provide the basis for the anti-virus therapy in HBV-GN patients.

关 键 词：肝炎 乙型 肾炎 DNA 病毒 

分 类 号：R692.3[医药卫生—泌尿科学] R512.62[医药卫生—外科学]