成人乙型肝炎病毒相关性肾炎患者肝肾病理损害的研究  

Pathological changes of liver and kidney in adult patients with hepatitis B virus-associated glomerulonephritis

作　　者：孙莉静[1] 郭志勇[1] 许静[1] 崔若兰[1] 于建平[1] 

机构地区：[1]第二军医大学附属长海医院肾内科,上海200433

出　　处：《上海医学》2009年第9期800-803,I0001,共5页Shanghai Medical Journal

摘　　要：目的观察成人乙型肝炎病毒相关性肾炎(HBV-GN)患者肝、肾病理损害的类型及乙型肝炎病毒抗原在肝、肾组织的分布。方法经肾脏活组织检查确诊的44例成人HBV-GN中,10例行肝脏活组织检查;肝、肾脏活组织检查标本均行常规光学显微镜、免疫荧光、免疫组织化学、原位分子杂交检查,并对肝、肾病变进行相关性分析。结果HBV-GN肾脏病理类型以IgA肾病(IgAN)为主(27.3%),其次为膜性肾病(MN,22.7%);不同病理类型肾组织中抗原的种类及分布有所不同,IgAN、系膜增生性肾炎(MsPGN)可见HBsAg和(或)HBcAg表达,MN、微小病变肾病(MCD)和膜增生性肾炎(MPGN)仅见HBsAg表达,HBV-DNA表达多位于肾小管上皮细胞的细胞质及细胞核内。肝脏病理改变多表现为轻度慢性肝炎(8/10),以HBsAg检出为主;中、重度慢性肝炎可同时检出HBsAg及HBcAg。结论本组成人HBV-GN患者肾脏的病理类型多样,以IgAN和MN多见;肝脏病变以轻度慢性肝炎为主。Objective To investigate the pathological changes of liver and kidney in adult patients with hepatitis B virus-associated glomerulonephritis（HBV-GN） and to observe the distribution of hepatitis B virus antigen in the livers and kidneys. Methods Forty-four HBV-GN patients were confirmed by renal biopsy, and ten of them also underwent liver biopsy. The morphological changes of biopsy specimens were observed by light microscopy and immunofluorescent staining; immunohistochemical techniques were used to observe HBV markers （HBsAg, HBcAg） in the renal and liver specimens; and HBVDNA was detected by molecular hybridization in situ. Results Histological findings indicated that IgA nephropathy （IgAN） was the dominant type in our group （27.3 % ）, followed by membranous nephropathy （MN） （22.7%）. HBsAg and/or HBcAg were presented in IgAN and mesangial proliferative glomerulonephritis （MsPGN）. HBsAg was only expressed in MN, minimal change disease （MCD） and membranoproliferative glomerulonephritis （MPGN）. HBV-DNA was mainly detected in the cytoplasm of proximal tubular epithelia but not in glomerular cells. Patients had different degrees of hepatic lesions, with mild lesions accounting for 80%; HBsAg was commonly observed in mild lesions. Presence of both HBcAg and HBsAg in the liver indicated the existence moderate and severe lesions. Conclusions HBV-GN patients have different types of renal lesions, with IgA and MN being the dominant types. The lesions of liver are mainly mild hepatitis. （Shanghai Med J, 2009, 32： 800-803）

关 键 词：乙型肝炎病毒相关性肾炎 肝脏病理 肾脏病理 

分 类 号：R512.62[医药卫生—内科学] R692.3[医药卫生—临床医学]