83例儿童乙型肝炎病毒相关肾炎的临床病理研究  

Clinicopathological Study on Hepatitis B Virus-Associated Glomerulonephritis in 83 Children

作　　者：刘志莹[1] 郑卫民[1] 彭晓杰[1] 

机构地区：[1]江西省儿童医院肾内科,南昌330006

出　　处：《江西中医药大学学报》2018年第1期41-43,99,共4页Journal of Jiangxi University of Chinese Medicine

摘　　要：目的:探讨儿童乙型肝炎病毒相关肾炎的临床及病理特点。方法:收集83例经肾活检确诊为HBV-GN患儿入院时的临床症状(如浮肿、血压、血尿)及实验室检查结果(如尿常规、24 h尿蛋白定量、乙肝五项、血白蛋白、血、尿HBV-DNA等)及肾脏病理检查结果(肾脏病理类型,免疫球蛋白、补体及HBs Ag、HBc Ag的沉积情况,肾小管、间质损害情况),并分析比较不同肾间质损害HBV-GN患儿临床病理特点。结果:临床表现:单纯性血尿4例(4.8%);单纯性蛋白尿8例(9.6%);血尿和蛋白尿15例(18%);肾病综合征(NS)56例(67%)。病理类型:膜性肾病(MN)61例(73.4%),系膜增生性肾小球肾炎(Ms PGN)13例(15.6%),膜增生性肾小球肾炎(MPGN)7例(8.4%),毛细血管内增生性肾小球肾炎(En PGN)2例(2.4%)。HBV-GN患儿肾间质损害积分与血、尿HBV-DNA载量呈正相关(r血=0.827,P=0.000,r尿=0.836,P=0.000)。中重度损害组肾组织乙肝病毒标志物以HBs Ag、HBc Ag同时沉积为主,且肾间质、肾小管上皮细胞都存在不同程度的乙肝病毒标志物沉积,而轻度损害组、无损害组以HBs Ag沉积为主,且肾小管上皮细胞和肾间质很少有沉积。结论:儿童HBV-GN发病男高于女,学龄期儿童多见。临床类型以肾病综合征为主,病理类型以MN为主。血、尿HBV-DNA水平与HBV-GN患儿肾间质损害程度有关。Objective： To explore clinicopathological feature of Hepatitis B Virus-associated Glomerulonephritis in Children. Methods：Clinicopathological feature of 83 children with HBV-GN proved by renal biopsy were analyzed. The clinical manifestation（ edema,blood pressure and hematuria） and laboratory examination data（ routine urianlysis,24 h urinary protein excretion,the marker of HBV infection,serum albumn,the serum level of HBV-DNA,the urinary level of HBV-DNA and other） in present were recorded. Pathological types and the deposit of immunoglobulin in renal tissue were also recorded. To record tubulointerstitial lesions and the deposit of HBs Ag and HBc Ag in renal tissue. To analyse clinicopathological feature of HBV-GN with different tubulointerstitial lesions. Results： The commonest clinical manifestation of HBV-GN was Nephrotic syndrome（ NS）（ 56/83,67%）,the second was hematuria with proteinuria（ 15/83,18%）. Proteinuria without hematuria was found in 8 cases（ 9. 6%）,hematuria without proteinuria was 4 cases（ 4. 8%）.MN was the prominent pathological types（ 61/83,73. 4%）,followed by Ms PGN（ 13/83,15. 6%） and MPGN（ 7/83,8. 4%）,En PGN was the rarest（ 2/83,2. 4%）. The level of tubulointerstitial lesions in HBV-GN closely correlated with the serum and urinary level of HBV-DNA（ r血= 0. 827,P = 0. 000,r尿= 0. 836,P = 0. 000）. The synchronous deposition of HBs Ag and HBc Ag was found in the heavier tubulointerstitial lesions groups. The commonest deposition of HBs Ag was found in the lighter tubulointerstitial lesions group.HBs Ag and HBc Ag of the heavier tubulointerstitial lesions group deposited in the tubular epithelial cell and renal interstitium. The deposition of the lighter tubulointerstitial lesions groups in the renal tubular epithelial cell and renal interstitium was almost negative. Conclusions： HBV-GN in children usually happened to school age children,with a strong male prominence,the commonest clinical manifestation of HBV-GN was NS. MN was the prominen

关 键 词：乙型肝炎病毒相关肾炎 肾间质损害 乙肝病毒DNA 

分 类 号：R692.3[医药卫生—泌尿科学]