不同病毒状态下乙型肝炎病毒相关性肾炎的表现特点  

The Manifestations of Hepatitis B Virus-associated Nephritis in Different Virus States

作　　者：李力鸿 李云生 沈金峰 陈玲伟 朱慧萍 LI Lihong;LI Yunsheng;SHEN Jinfeng(The First People's Hospital of Wealing City,Zhejiang,Wealing,317500)

机构地区：[1]浙江省温岭市第一人民医院,温岭317500

出　　处：《中国中西医结合肾病杂志》2021年第9期778-782,共5页Chinese Journal of Integrated Traditional and Western Nephrology

基　　金：台州市科技计划项目(No.20ywb141)。

摘　　要：目的:分析高、低病毒载量状态下乙型肝炎病毒相关性肾炎(hepatitis bvirus-associated glomerulonephritis,HBV-GN)临床、病理、肝肾功能、免疫及炎症区别,提高对HBV-GN的认识,为临床诊治提供新的思路。方法:回顾性分析2015年10月—2020年12月我院行肾穿刺活检且诊断为HBV-GN 84例。分析HBV-GN患者肝肾功能与TLR4关系。将84例患者依据乙肝DNA病毒定量分为两组,高病毒载量为A组34例,低病毒载量为B组50例,观察其临床表现、病理特点及肾功能[血清肌酐(serum creatine,Scr)、尿素氮(blood urea nitrogen,BUN)、估算肾小球滤过率(estimated glomerular filtration rate,eGFR)、尿N-乙酰-β-D氨基葡萄糖苷酶(N-acetyl-β-Dglucosaminidase,NAG)、尿β_(2)微球蛋白(β_(2)-microglobulin,β_(2)-MG)]、白蛋白(albumin,Alb)、24 h尿蛋白定量(24-hour-urine total protein,24 h TP)、尿红细胞数量、肝功能[谷草转氨酶(glutamic oxalacetic transaminase,AST)、丙氨酸转氨酶(alanine aminotransferase,ALT)]、T细胞亚群(CD_(3)^(+)、CD_(4)^(+)、CD_(8)^(+)、CD_(4)^(+)/CD_(8)^(+))、炎症指标[白细胞介素-2(in terleukin-1,IL-2)、白细胞介素-6(in terleukin-6,IL-6)、肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)、干扰素-γ(Interferon-γ,INF-γ)、Toll样受体4(toll-like receptor4,TLR4)、髓样分化因子88(myeloid differentiation factor 88,MyD88)、核转录因子-κB(nuclear factor-κB,NF-κB)]水平。结果:(1)在HBV-GN患者中,ALT与Scr存在一定相关性,即ALT越高,则相应Scr也升高,同时TLR4与ALT、Scr存在一定相关性,即TLR4越高,则ALT、Scr值也越高;(2)高病毒载量HBV-GN患者临床以肾病综合征表现为主,而低病毒载量HBV-GN患者临床以肾炎综合征表现为主(P>0.05)。(3)无论高、低病毒载量HBV-GN患者中,病理表现相似(P<0.05),膜性肾病占比最多,其次为膜增生性肾小球肾炎、毛细血管内增生性肾小球肾炎,局灶节段肾小球硬化、系膜增生性病变较为少见。(4)�Objective:To analyze the clinical,pathological,liver and kidney function,immunity and inflammation differences of Hepatitis B virus-associated glomerulonephritis(HBV-GN)in high and low viral load states,and to improve the understanding of HBV-GN,Provide new ideas for clinical diagnosis and treatment.Methods:A retrospective analysis of 84 cases of renal biopsy and diagnosis of HBV-GN in our hospital from October 2015 to December 2020.Analyze the relationship between liver and kidney functions of HBV-GN patients with TLR4,MyD88,andNF-κB.The 84 patients were divided into two groups based on the hepatitis B DNA virus quantitatively.The high viral load was group A with 34 cases,and the low viral load was divided into group B with 50 cases.The clinical manifestations,pathological characteristics and renal function were observed[serum creatinine(Scr),blood urea nitrogen(BUN),estimated glomerular filtration rate(eGFR),urinary N-acetyl-β-D glucosidase(NAG),urineβ_(2)microglobulin(β_(2)-MG)],albumin(Alb),24-hour-urine total protein(24 h TP),urine red blood cell number,Liver function[glutamic oxalacetic transaminase(AST),alanine aminotransferase(ALT)],T cell subsets(CD_(3)^(+),CD_(4)^(+),CD_(8)^(+),CD_(4)^(+)/CD_(8)^(+)),inflammation indicators[interleukin-2(IL-2),interleukin-6(IL-6),tumor necrosis factor-a(TNF-α),interferon-γ(INF-γ)),Toll-like receptor4(TLR4),myeloid differentiation factor 88(MyD88),nuclear factor-κB(NF-κB)]levels.Results:(1)In HBV-GN patients,there is a certain correlation between ALT and Scr,that is,the higher the ALT,the corresponding Scr is also increased,and there is a certain correlation between TLR4 and ALT and Scr,that is,the higher the TLR4,the higher the ALT and Scr.The Scr value is also higher;(2)The clinical manifestations of high viral load HBV-GN patients are mainly nephrotic syndrome,while the clinical manifestations of low viral load HBV-GN patients are mainly nephritis syndrome(P>0.05).(3)In patients with HBV-GN regardless of high or low viral load,the pathological findings were s

关 键 词：乙型肝炎病毒相关性肾炎 炎症 免疫 

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