成人乙型肝炎病毒相关性肾小球肾炎的临床及病理特点分析  

Clinical and pathological characteristics of hepatitis B virus-associated glomerulonephritis in adults

作　　者：程文荣 孙丽君[1] 董鸿瑞[1] 王国勤[1] 程虹[1] Cheng Wenrong;Sun Lijun;DongHongrui;Wang Guoqin;Cheng Hong(Division of Nephrology,Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院肾内科,100029

出　　处：《国际病毒学杂志》2021年第3期231-235,共5页International Journal of Virology

基　　金：北京市自然科学基金(7192050)。

摘　　要：目的:分析成人乙型肝炎病毒相关性肾小球肾炎(Hepatitis B virus-associated glomerulonephritis,HBV-GN)的临床及病理特点,初步探讨PLA2R对HBV相关膜性肾病(membranousnephropathy,MN)预后的可能影响。方法:回顾分析本中心31例HBV-GN患者,分为青年组(≤35岁)和中年组(>35岁),比较两组间的临床及病理资料。分析HBV-MN患者肾小球PLA2R和THSD7A的抗原表达。结果:HBV-GN患者中肾病综合征占54.8%,病理为MN占77.4%,约77.4%伴镜下血尿,青年组肾功能更好(P<0.05)。HBV-GN患者肾组织HBsAg和HBcAg同时阳性为主,伴多种免疫复合物沉积。青年组HBV-MN比例更高,而膜增生性肾小球肾炎只分布在中年组(P<0.05)。2例HBV-MN患者肾小球PLA2R为阳性(8.3%),IgG亚型以IgG4为主,其中1例在84月随诊时出现肾功能进展。结论:成人HBV-GN常见临床表现为肾病综合征,伴镜下血尿多见,青年组肾功能更好。病理类型主要为MN,HBV-MN患者很少伴PLA2R阳性,但伴PLA2R阳性时可能提示肾脏预后不佳。PLA2R对HBV-MN预后的影响尚需进一步机制探讨。Objective To analyze the clinicopathological characteristics of hepatitis B virus-associated glomerulonephritis(HBV-GN)in adults,and to explore the effects of glomerular M-type phospholipase A2 receptor(PLA2R)expression on prognosis of HBV-associated membranous nephropathy(HBV-MN).Methods Thirty-one HBV-GN patients were enrolled in this study.They were divided into young group(≤35 years old)and middle-aged group(>35 years old).The clinical and pathological data were compared between the two groups.The glomerular expression of PLA2R and THSD7A were analyzed in HBV-MN patients.Results HBV-GN patient were mainly nephrotic syndrome(NS),accounting for 54.8%.The main pathological manifestations of HBV-GN were MN,accounting for 77.4%.Among HBV-GN patients,77.4%had microscopic hematuria.The young group had better renal function(P<0.05).HBsAg and HBcAg codepositions were the most common pattern in HBV-GN patients,accompanied by more than one immunoglobulins codeposition.The proportion of HBV-MN was higher in young group,and membranoproliferative glomerulonephritis were all in the middle-aged group(P<0.05).Two patients of HBV-MN were glomerular PLA2R positive(8.3%)and the IgG subtypes were mainly IgG4.One of the patients developed renal function decline after 84 months follow-up.Conclusions NS was the main clinical manifestation of HBV-GN in adults,with more microscopic hematuria.The young group had better renal function.The main pathological pattern was MN.The positive expression of PLA2R was rarely found in HBV-MN patients,but positive PLA2R expression indicated poor prognosis.The effect of PLA2R onprognosis of HBV-MN needs further study.

关 键 词：乙型肝炎病毒相关性肾小球肾炎 肾病综合征 膜性肾病 M型磷脂酶A2受体 1型血小板反应蛋白7A域 

分 类 号：R512.62[医药卫生—内科学] R692.31[医药卫生—临床医学]