乙肝病毒相关性肾炎的临床病理和治疗分析  

Clinical and pathologic characteristics of hepatitis B virus-associated glomerulonephritis and the curativeeffect of antivirai therapy

作　　者：刘俊兰[1] 凌毅生[1] 关天俊[1] 

机构地区：[1]厦门大学附属中山医院肾内科,厦门361004

出　　处：《临床肾脏病杂志》2013年第12期554-557,共4页Journal Of Clinical Nephrology

摘　　要：目的分析乙肝病毒相关性肾炎的临床、实验室指标、病理特点及抗病毒治疗的疗效。方法对53例乙肝病毒相关性肾炎患者临床表现、肝功能、肾功能、乙肝病毒血清标志物、乙肝病毒DNA以及病理分型进行分析，观察乙肝病毒DNA与临床表现之间的相关性，并根据乙肝病毒复制情况和蛋白尿的水平进行分组，给予核苷类似物抗病毒治疗，观察治疗效果。结果肾病综合征21例，肾炎综合征32例，48例患者合并血尿，合并肾功能不全患者3例。肾活检病理结果显示膜性肾病占49．06％，膜增生性。肾小球肾炎占3（）．19％，继发性IgA肾病占20．75％。乙肝病毒DNA载量与24h尿蛋白定量呈正相关。19例患者使用核苷（酸）类似物拉米夫定和恩替卡韦抗病毒治疗6个月，乙肝病毒DNA载量显著下降，乙肝病毒相关性‘肾炎完全缓解2例，部分缓解6例。结论乙肝病毒相关性肾炎具有特殊临床表现与肾脏病理特征，乙肝病毒DNA载量与蛋白尿水平呈正相关。抗病毒治疗可在部分患者中获得完全和部分缓解。Objective To analyze the clinical and pathologic characteristics of hepatitis B virus （HBV）-associated glomerulonephritis and the curative effect of antiviral therapy. Methods Fifty-three cases of HBV-associated nephritis were enrolled in this study. We observed the clinical manifestations and pathological classifications of these patients, and studied the relationship between HBV-DNA repli- cation level and clinical manifestations. Special antiviral treatments were given according to the situa- tion of HBV replication and the level of proteinuria, and the curative effects were observed. Results There were 21 cases of nephrotic syndrome,32 cases of nephritis syndrome,48 cases of hematuria,and 3 cases of renal insufficiency. Renal biopsy pathology results showed that the membranous nephropathy accounted for 49. 06% ,membrane proliferative glomerulonephritis for 30. 19~ ,and secondary IgA ne- phropathy for 20. 75%. HBV-DNA replication levels were positively correlated with 24-h urinary pro- tein levels. After 6~month antiviral treatment on 19 cases,2 eases obtained complete remission, and 6 cases obtained partial remission. Conclusions The HBV-associated glomerulonephritis has special clin- ical manifestations and pathological characteristics. Antiviral treatment can obtain complete and partial response in some patients.

关 键 词：乙肝病毒 血尿 治疗 

分 类 号：R692.3[医药卫生—泌尿科学]