血清 HBV DNA 定量与 HBV 相关性肾炎患者临床病理特征及预后的相关性  

Correlation of serum HBV DNA level with clinicopathological characteristics and prognosis of hepatitis B virus-associated glomerulonephritis

作　　者：蒋伟[1] 董晖[1] 刘拓[2] 刘丽秋[1] 徐岩[1] 关广聚[3] 刘向春[3] 

机构地区：[1]青岛大学附属医院肾内科,266003 [2]中国疾病预防控制中心职业卫生与中毒所 [3]山东大学第二医院肾内科

出　　处：《中华临床感染病杂志》2014年第6期500-505,共6页Chinese Journal of Clinical Infectious Diseases

基　　金：山东省高等学校科技计划项目（J11LF21）

摘　　要：目的：探讨HBV相关性肾炎（ HBV-GN）患者血清HBV DNA复制水平与临床病理特征及预后的相关性。方法选取2009年1月至2012年10月在青岛大学附属医院接受治疗的HBV-GN患者102例。采用荧光定量聚合酶链反应法测定所有患者血清HBV DNA载量，并依此将患者分为HBV DNA低度复制组（ HBV DNA＜103拷贝／mL）、HBV DNA中度复制组（103拷贝／mL≤HBV DNA≤105拷贝／mL）和HBV DNA高度复制组（ HBV DNA﹥105拷贝／mL）。所有患者行肾脏穿刺活检，明确病理类型，并进行肾脏组织中HBV相关抗原（ HBsAg、HBcAg及HBeAg）的免疫荧光定量检测。所有患者均接受拉米夫定（100 mg／d）联合阿德福韦酯（10 mg／d）治疗，随访观察18个月，并对各组患者治疗前后的肾功能和生化免疫学指标进行比较。采用One-way ANOVA单因素方差分析比较不同HBV DNA复制水平的患者肾功能、生化免疫学指标、肾脏组织中HBV相关抗原沉积的差异，并采用Spearman相关分析法分析血清HBV DNA水平与肾脏病理分期的相关性。结果102例患者中， HBV DNA低度复制组20例，HBV DNA中度复制组51例，HBV DNA高度复制组31例。随着血清HBV DNA复制水平的增高，患者24 h尿蛋白定量、胆固醇及三酰甘油呈现不同程度的增加（ F＝34.64，40.10和31.72，P＜0.01），血浆白蛋白降低（F＝24.04，P ＜0.01）；肾脏组织中 HBV 抗原（HBsAg、HBcAg及HBeAg）免疫复合物的沉积增加（F＝41.49，15.64和10.41，P＜0.01）。对78例膜性肾病（MN）患者分析发现，随着血清HBV DNA复制的增加，HBV-MN患者病理分期加重（r＝0.38， P＜0.01）。抗病毒治疗后，各组24 h尿蛋白排泄量较治疗前均显著下降（ t＝7.86，19.28和16.74， P＜0.01）；补体C3较治疗前上升，但与治疗前比较差异无统计学意义（t＝1.05，1.04和1.94，P＞0.05）；血肌酐较治疗前无明显变化（ t＝0.14，0.52和0.57，P＞0.05）。治�Objective To investigate the correlation of HBV DNA level with clinicopathological characteristics and prognosis of HBV-associated glomerulonephritis （ HBV-GN ） .Methods One hundred and two patients with HBV-GN admitted in Affiliated Hospital of Qingdao University during January 2009 and＆amp;nbsp;October 2012 were successively enrolled.Fluorescence quantitative polymerase chain reaction was used to determine the serum titer of HBV DNA.According to HBV DNA levels the patients were divided into three groups：low-replication group （HBV DNA 〈103 copies/mL）, moderate-replication group （103 copies/mL ≤HBV DNA≤105 copies/mL） and high-replication group （ HBV DNA 〉105 copies/mL） .Renal biopsy was performed to determine the pathological type, and immunofluorescence assay was used for quantitative detection of HBV related antigens （ HBsAg, HBcAg and HBeAg ） in kidney. All patients received lamivudine （100 mg/d） plus adefovir dipivoxil （10 mg/d） combination therapy and followed up for 18 months.The renal function, biochemical and immunological indexes before and after the treatment were measured.One-way ANOVA was used to analyze the differences of above parameters among patients in three groups.Spearman correlation coefficient was used for correlation analysis between HBV DNA level and pathological stages in kidney.Results There were 20 patients in low-replication group, 51 in moderate-replication group and 31 in high-replication group.With the increase of serum level of HBV DNA, 24-h urine protein excretion, plasma cholesterol, and triglycerides increased （F=34.64, 40.10 and 31.72, P〈0.01）, plasma level of albumin decreased （F=24.04, P〈0.01）, and the immune complexes of HBV related antigens （ HBsAg, HBcAg and HBeAg） in kidney increased （ F=41.49, 15.64 and 10.41, P〈0.01）.For 78 patients with HBV-membranous nephropathy （ HBV-MN）, the pathological injury was aggravated with the increase of serum level of HBV DNA （r=0.38, P〈0.01）.The level of 24-h urine pro

关 键 词：肝炎病毒 乙型 肾炎 病理学 预后 

分 类 号：R512.62[医药卫生—内科学]