肾组织伴有或无乙型肝炎病毒抗原沉积的老年患者临床和病理对比分析  

Comparative analysis of clinicopathological features in elderly patients with versus without hepatitis B virus antigen deposition in renal tissue

作　　者：罗杰 杨枫 陈小青 黄娟 陈建 Luo Jie;Yang Feng;Chen Xiaoqing;Huang Juan;Chen Jian(Department of Nephrology,Affihiated Fuzhou First Hospital of Fujian Medical University,Fuzhou 350009,China;Department of Nephrology,the 90^th Hospital of the United Nactions Support Force,Fuzhou 350025;Department of Nephrology,the 184^th Hospital of PLA Yingtan 33500,China)

机构地区：[1]福建医科大学附属福州市第一医院肾内科,福州350009 [2]联勤保障部队第九〇〇医院肾内科,350025 [3]江西解放军184医院肾内科,鹰潭335000

出　　处：《中华老年医学杂志》2020年第3期291-296,共6页Chinese Journal of Geriatrics

基　　金：福州市临床重点专科建设项目。

摘　　要：目的通过对肾组织伴有或无乙型肝炎病毒(HBV)抗原沉积的老年患者的临床和病理资料进行对比分析,进一步探讨老年乙肝相关性肾炎的临床和病理特点。方法对联勤保障部队第九〇〇医院年龄≥60岁的33例乙肝相关性肾炎(HBV-GN)和27例乙肝合并肾炎(HBV-CG)患者的临床、病理资料进行回顾性分析及统计学比较。结果(1)两组均以男性[26例(78.8%)和21例(77.8%)]多见,临床表现均以肾病综合征[18例(54.5%)和15例(55.6%)]为主,其中HBV-GN组合并高血压者明显多于HBV-CG组;(2)两组均以膜性肾病(MN)为主要病理类型,其中HBV-GN组病理类型为膜增生性肾小球肾炎(MPGN)者明显多于HBV-CG组;(3)HBV-GN组在"大三阳"及高病毒载量者所占比例上均明显高于HBV-CG组;(4)HBV-GN组肾组织可观察到多种免疫复合物沉积的现象,即"满堂亮";(5)HBV-GN组病理改变不同于HBV-CG组之处:具有不典型MN的表现;各病理类型肾组织中偶可观察到新月体形成;局灶节段肾小球硬化(FSGS)中可有基底膜增厚的表现;(6)HBV-GN组在肾小管及间质病变的发生率及病变程度上均明显高于HBV-CG组。结论尽管老年HBV-GN与HBV-CG在临床表现及检验指标上有诸多相似之处,但HBV-GN者在血清病毒学及病理改变上仍与HBV-CG者存在较大的区别。因此对于该类老年患者,应重视血清HBV复制及肾脏病理改变情况,进而为治疗提供临床依据。Objective To compare and analyze the clinicopathological data of elderly patients with versus without hepatitis B virus(HBV)antigen deposition in renal tissue,and to investigate the clinicopathological features in elderly patients with HBV associated nephritis(HBV-GN).Methods The clinicopathological data of 33 patients with HBV-GN and 27 patients with hepatitis B and nephritis(HBV-CG)aged≥60 years in the 90^th Hospital of the United Nations Support Force were retrospectively analyzed and statistically analyzed.Results(1)Both the HBV-GN and HBV-CG groups were often men[26(78.8%)vs.21(77.8%)]and had high rate of nephritic syndrome[18(54.5%)vs.15(55.6%)].And patients in the HBV-GN group had higher incidence of hypertension than that in the HBV-CG group;(2)Membranous nephropathy(MN)was the main pathological type in both groups,and the rate of membrane proliferative glomerulonephritis(MPGN)was more found in the HBV-GN group than the HBV-CG group;(3)The proportion positive HBsAg,HBeAg and HBcAb test resultsand high viral load was significantly higher in the HBV-GN group than that in the HBV-CG group;(4)Multiple immune complex deposits were observed in the renal tissues of HBV-GN group,which was called the phenomenon of"all bright";(5)The pathological features in the HBV-GN group showed untypical manifestation of MN,the occasionally observed crescent formation,and the thickening of basement membrane in focal segmental glomerulosclerosis;(6)The incidence and the severity of renal tubule and interstitial lesions in HBV-GN group were significantly higher than those in HBV-CG group.Conclusions Although there are many similarities in clinical manifestations and testing indicators between the elderly HBV-GN and HBV-CG patients,HBV-GN patients are still significantly different from HBV-CG patients in terms of serum virology and pathological changes.Therefore,we should pay attention to the serum HBV replication and renal pathological changes to provide a clinical basis for treating this kind of elderly patients.

关 键 词：乙型肝炎病毒相关性肾炎 乙型肝炎病毒感染合并肾炎 病理学 临床 

分 类 号：R51[医药卫生—内科学] R692[医药卫生—临床医学]