不同染色方法检测HBsAg阳性患者肾组织中乙肝抗原的效果比较  

Comparison of immunofluorescent staining with immunohistochemistry in detection of HBcAg and HBcAg in renal biopsy specimens

作　　者：汤绚丽[1] 孙琳[1] 朱晓玲[1] 胡云琴[1] 闵曼[1] 

机构地区：[1]杭州市中医院肾内科(浙江省肾脏疾病防治技术研究重点实验室),310007

出　　处：《浙江医学》2014年第1期12-15,共4页Zhejiang Medical Journal

基　　金：浙江省医药卫生科技计划项目(2011KYB081);杭州市科技局重点专科专病项目(20100733Q29)

摘　　要：目的探讨不同染色方法检测HBsAg阳性患者肾组织中乙肝抗原的效果。方法收集血清HBsAg阳性的肾穿刺患者77例,分别采用免疫荧光法和改良免疫组化法检测肾组织HBsAg及HBcAg阳性表达情况。结果继发于乙肝病毒感染相关的肾小球肾炎(HBV-GN)中,HBsAg免疫荧光法及改良免疫组化法敏感性为48.1%及100%;HBcAg免疫荧光法及改良免疫组化法敏感性为22.2%及70.4%,差异均有统计学意义(均P<0.01)。非乙肝相关性肾小球肾炎(NHBV-GN)中,HBsAg免疫荧光法及改良免疫组化法特异性为98%及96%;HBcAg免疫荧光法及改良免疫组化法特异性为100%及96%,两种方法特异性均较高,差异均无统计学意义(均P>0.05)。乙肝抗原血症者肾组织HBsAg及HBcAg改良免疫组化法平均阳性强度明显高于免疫荧光法(P<0.01)。血清乙肝"大三阳"、DNA复制者HBsAg改良免疫组化法检测阳性强度均明显高于"小三阳"及DNA不复制者(P<0.05或0.01)。结论改良免疫组化染色法提高了乙肝抗原血症者肾组织乙肝抗原的检出率及肾小球疾病尤其是HBV-GN诊断的准确性,同时HBsAg阳性强度还可预测乙肝感染严重程度。Objective To compare two immunochemical methods in detection of HBsAg and HBcAg in renal biopsy specimens. Methods Renal biopsy samples were taken from 77 HBsAg positive patients with nephritis. HBsAg and HBcAg in renal tissue were detected by indirect immunofluorescent staining （IIFS） and improved immunohistochemical staining （IIHS）, re-spectively. Results In patients with hepatitis B virus- related glomerular nephritis（HBV- GN） the sensitivity of HBsAg detected by IIHS and IIFS was 100.0% and 48.1%, respectively （P〈0.01）; that of HBcAg was70.4% and 22.2%, respectively （P〈0.01）. In non- HBV- GN patients, the specificity of HBsAg detected by IIFS and IIHS was 98.0% and 96.0% respectively, while that of HBcAg was 100.0%and 96.0%（P〉0.05）. The intensity score of HBsAg was 0.15 by IIFS and 0.74 by IIHS, while that of HBcAg was 0.04 by IIFS and 0.22 by IIHS, respectively （both P〈0.01）. The intensity scores of HBsAg in patients with serum positive HB-sAg, HbeAg and positive HBV- DNA were significantly higher than those with positive HBsAg, HBeAb, HBcAb and negative HBV- DNA（P〈0.05 or 0.01）. Conclusion The improved immunohistochemical staining method can increase the detection rate of renal HBAg in HBV- GN patients;and the intensity score of HBsAg is predictable for the severity of HBV infection.

关 键 词：乙肝抗原血症 乙肝相关性肾小球肾炎 免疫荧光法 改良免疫组化法 

分 类 号：R512.62[医药卫生—内科学]