肾小管HBV抗原阳性表达与HBV相关性肾炎预后的关系  

Relationship between positive expression of renal tubule HBV antigen and prognosis of HBV⁃associated glomerulonephritis

作　　者：罗志立 周红梅 乐丽 林利容 LUO Zhii;ZHOU Hongmei;LE Li;LIN Lirong(Department of Renal Immunoendocrine,Zhongxian People's Hospital,Chongqing,China,404300;Department of Nephrology,the Third Affiliated Hospital of Chongqing Medical University,Chongqing,China,401120)

机构地区：[1]重庆市忠县人民医院肾脏免疫内分泌科,重庆404300 [2]重庆医科大学附属第三医院肾内科,重庆401120

出　　处：《分子诊断与治疗杂志》2023年第10期1837-1840,1845,共5页Journal of Molecular Diagnostics and Therapy

基　　金：重庆市科卫联合医学科研项目(2021MSXM1236)。

摘　　要：目的 探讨肾小管乙型肝炎病毒(HBV)抗原阳性表达与乙型肝炎病毒相关性肾炎(HBV-GN)患者预后的关系。方法 选择2019年6月至2022年6月重庆市忠县人民医院及重庆医科大学附属第三医院收治的HBV-GN患者96例,行肾脏病理检查、血清学指标和HBV-DNA载量检测,根据肾小管中HBV抗原表达分为阳性组51例、阴性组45例,并根据患者是否发生主要终点事件和(或)次要终点事件判定预后,将患者分为预后不良组和预后良好组。采用logistics回归模型分析影响HBV-GN预后的因素。结果 阳性组肾功能损害和血清HBsAg、HBeAg阳性比例及血肌酐水平均高于阴性组,差异有统计学意义(P<0.05);预后不良者共16例,阳性组预后不良率25.64%,高于阴性组的5.71%,差异有统计学意义(P<0.05);预后不良者肾功能损害和血清HBsAg、HBeAg阳性比例高于预后良好者,差异有统计学意义(P<0.05);预后不良与预后良好者的HBV-DNA低度、中度和高度复制比例比较差异有统计学意义(P<0.05);肾功能损害、血清HBsAg阳性、血清HBeAg阳性、高水平Scr、肾小管HBV抗原阳性、HBV-DNA高度复制是HBV-GN预后不良的危险因素(P<0.05)。结论 肾小管HBV抗原阳性表达的HBV-GN患者肾功能损害更严重,存在更高预后不良风险。Objective To investigate the relationship between positive expression of renal tubule hepatitis B virus(HBV)antigen and prognosis of patients with hepatitis B virus-associated glomerulonephritis(HBV-GN).Methods Totally 96 patients with HBV-GN in Chongqing Zhongxian People's Hospital and the Third Affiliated Hospital of Chongqing Medical University were selected between June 2019 and June 2022.Renal pathological examination,serological indicator detection and HBV-DNA load detection were performed.The patients were divided into the positive group(51 cases)and the negative group(45 cases)according to the HBV antigen expression in renal tubule,and patients with ineffective treatment or death,doubled serum creatinine and end-stage renal disease are judged to have poor prognosis,and logistics regression model was used to analyze the factors affecting the prognosis of HBV-GN.Results The proportions of renal impairment,serum positive HBsAg and serum positive HBeAg and serum creatinine level in the positive group were higher than those in the negative group(P<0.05).There were 16 cases of poor prognosis.The poor prognosis rate in the positive group was higher than that in the negative group(25.64%vs 5.71%)(P<0.05).The proportions of renal impairment,serum positive HBsAg and serum positive HBeAg of patients with poor prognosis were higher than those of patients with good prognosis(P<0.05).There were significant differences in the proportions of HBV-DNA low replication,moderate replication,and high replication between patients with poor prognosis and patients with good prognosis(P<0.05).Renal impairment,serum positive HBsAg,serum positive HBeAg,high-level Scr,positive expression of HBV antigen in renal tubules and high HBV-DNA replication were risk factors for poor prognosis of HBV-GN(P<0.05).Conclusion Patients with HBV-GN and positive expression of HBV antigen in renal tubules may have more serious renal impairment and higher risk of poor prognosis.

关 键 词：肾小管 乙型肝炎病毒抗原 乙肝病毒相关性肾炎 

分 类 号：R512.62[医药卫生—内科学] R692.3[医药卫生—临床医学]