205例乙型肝炎病毒相关性肾炎的临床及病理研究  

Clinicopathological analysis on hepatitis B virus-associated glomerulonephritis in 205 patients

作　　者：魏日胞[1] 李平[1] 吴杰[1] 张雪光[1] 尹忠[1] 师锁柱[1] 陈香美[1] 

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

出　　处：《中华实验和临床病毒学杂志》2010年第6期464-467,共4页Chinese Journal of Experimental and Clinical Virology

基　　金：国家自然科学基金重点课题（编号30630033）;全军医药卫生科研基金课题（编号06MA265）

摘　　要：目的 探讨乙型肝炎病毒相关性肾炎（Hepatitis B Virus-Associated Glomerulonephritis,HBV-GN）的临床表现、肾脏病理改变及与肝肾损害的关系,为HBV-GN早期诊治提供依据.方法 对解放军总医院肾科1995年9月至2008年11月经肾活检确诊HBV-GN并资料完整的205例患者临床及病理特点进行分析.结果 本组患者占同期肾活检5.6%.患者男性157例（76.5%）,女性48例（24.5%）;发病年龄3～65岁,平均37.79岁,19～45岁123例（60%）.以肾脏疾病首发95例（46%）,乙肝标记物大三阳者96例（46.8%）.临床表现为肾病综合征102例（49.8%）,肾功能不全18例（8.8%）;肝功能受损56例（27.3%）,合并肝硬化者18例（8.8%）.肝功能是否异常和肾脏临床表现及病理类型差异无统计学意义（P＞0.05）;乙肝病毒复制载量与尿蛋白定量呈正相关（P＜0.05）.病理表现以膜性肾病为主,占124例（60.5%）.结论 HBV-GN患者以中青年男性为主;临床表现以肾病综合征为主,病理以膜性肾病多见,近10%患者肾活检时已出现肾功能不全;乙肝病毒复制载量与尿蛋白定量呈正相关,但HBV对肝脏及肾脏的损伤具有不同步性.我国为HBV高感染国家,需要防治乙型肝炎患者继发肾脏受损,提高HBV-GN的早期诊断率及治疗率.Objective To investigate liver and kidney lesions in HBV-GN patients and relationship between them and provide evidences to make early diagnosis of HBV-GN. Methods Reviewing the clinicopathological and laboratory indexes of 205 patients with HBV-GN diagnosed by renal biopsy in our hospital from Semptember 1995 to November 2008. Results HBV-GN account for 5.6% of all renal biopsies at the same time. Among them, 157 （76. 5% ） patients were male, 123 （60%）was 19-45 years-old.95（46% ）patients break out with kidney disease. HBsAg, HBeAg, HBcAg were the most common HBV makers. 102（49.8% ） patients present nephrotic syndrome, 18（8.8% ） suffered kidney dysfunction; 18 patients with hepatic cirrhosis. Patients with or without liver disfunction got no different in clinic manifestation and renal pathology. With the rising of the content of HBV-DNA in surum,the urinary protein increases.Renal data shows that membranous nephropathy（MN） was the most frequent type（60. 5% ）. Conclusion males. Nephrotic syndrome was the most common clinic manifestation and membranous nephropathy was the most common pathology. 10% persent patisnts had loss of renal function at the time of renal biopsy. The HBV copies in serum correlated with the albuminuria. HBV-GN patients had desynchroneity lesions in kidney and liver. As the high rate of HBV infection in China, It needs to prevent the kidney damage in HBV infecious people and to elevate early diagnosis and therapy.

关 键 词：肝炎病毒 乙型 肾小球肾炎 临床表现 病理学 

分 类 号：R51[医药卫生—内科学] R692[医药卫生—临床医学]