乙肝相关性肾炎的临床病理特征分析及Foxp3在肾组织中的表达

发布时间：2018-05-11 02:15

本文选题：乙型肝炎 + 肾小球肾炎　；参考：《新疆医科大学》2013年硕士论文

【摘要】：目的：探讨我院近10年以来收集的乙肝相关性肾炎（HBV-GN）患者临床及病理特征，提高诊治水平；并分析叉状头/翅膀状螺旋转录因子（Foxp3）在乙型肝炎病毒相关性肾炎（HBV-GN）肾组织中表达及其可能作用。方法：（1）收集并回顾性分析经肾活检确诊为乙肝相关性肾炎58例患者临床表现、实验室检查指标、肾活检病理资料，记为A组；（2）选取同期行肾组织活检、病例资料完整的52例肾组织活检证实为肾炎但血清及肾组织中HBsAg均阴性，为非乙肝肾炎组，记为B组，24例患者血清HBsAg阳性、肾组织中HBsAg阴性，血清肌酐轻度升高经肾组织活检排除肾炎，为HBV感染组，记为C组。利用免疫组织化学法检测三组患者肾组织Foxp3、CD4、CD25蛋白表达情况。结果：（1）乙肝相关性肾炎发病年龄集中在(26.7±10.3)岁；男女比例为（2.2:1）；临床上以肾病综合征为主要表现者27例（46.6%），肾炎综合征者24例（41.4%），慢性肾功能不全占4例（6.9%），无症状性血尿或蛋白尿者3例（5.2%）；病理类型：膜性肾病占25例（43.1%），系膜增生性肾小球肾炎占16例（27.6%），膜增殖性肾小球肾炎占9例（15.5%），IgA肾病占6例（10.3%），硬化性肾小球肾炎占2例（3.4%）；血清HBeAg阴性组有43例（74.1%），血清补体C3水平为（0.99±0.27）g/l，，肾组织补体C3、C1q沉积率分别为34.9%、16.3%；血清HBeAg阳性组有15例（25.9%），血清补体C3水平为（0.19±0.17）g/l，肾组织补体C3、C1q沉积率分别为80%、46.7%，两组比较差异均具有统计学意义(P＜0.05)；HBV DNA中度复制组较低度复制组24小时尿蛋白定量升高，血清白蛋白水平降低(P＜0.05)。（2）在A组与B组肾小管间质中，每高倍镜视野下Foxp3+淋巴细胞、CD4+T细胞、CD25+T细胞数分别为（3.41±1.16）vs（3.52±1.27）；（2.78±0.15）vs（3.12±0.17）；（2.90±0.20） vs（3.09±0.18），均明显低于C组Foxp3+淋巴细胞数、CD4~+T细胞、CD25+T细胞数（P均＜0.05）；A组与B组比较，差异有统计学意义（P＜0.05），且A组中Foxp3、CD4、CD25的表达低于B组。结论：（1）HBV-GN以男性多见，临床以肾病综合征为主要表现，病理类型以膜性肾病为主，HBV DNA水平与尿蛋白定量及血清白蛋白水平有一定相关性。补体C3及C1q的激活可能参与了血清HBeAg阳性组HBV-GN的发病机制；（2）调节性T细胞Foxp3表达水平的下调可能与乙肝相关性肾炎的发生发展有关。
[Abstract]:Objective: to investigate the clinical and pathological features of HBV-GNN patients collected in our hospital in recent 10 years and to improve the diagnosis and treatment level. The expression and possible role of fork head / wing spiral transcription factor Foxp3 in the renal tissue of HBV-GNN were analyzed. Methods 58 patients with hepatitis B associated glomerulonephritis confirmed by renal biopsy were collected and analyzed retrospectively. The clinical manifestations, laboratory indexes and pathological data of renal biopsy were recorded as group A (n = 58). 52 cases of renal tissue biopsy confirmed nephritis, but HBsAg was negative in serum and renal tissue, and 24 cases in group B were positive for serum HBsAg and negative for HBsAg in renal tissue. Mild elevated serum creatinine was excluded from glomerulonephritis by renal biopsy. It was classified as HBV infection group and C group. The expression of Foxp3 + CD4 + CD25 protein in renal tissue of three groups was detected by immunohistochemical method. Results the age of hepatitis B associated glomerulonephritis was 26.7 卤10.3 years old. There were 27 cases with nephrotic syndrome, 24 cases with nephritis syndrome, 4 cases with chronic renal insufficiency, 3 cases with asymptomatic hematuria or proteinuria, and 25 cases with membranous nephropathy. There were 16 cases of Mesangial proliferative glomerulonephritis, 9 cases of proliferative glomerulonephritis, 6 cases of membranous proliferative glomerulonephritis and 6 cases of sclerosing glomerulonephritis and 2 cases of sclerosing glomerulonephritis, and 43 cases of serum HBeAg negative group were 74.1, the level of serum complement C3 was 0.99 卤0.27 g / L, the complement of renal tissue was 0.99 卤0.27 g / l. The deposition rates of C _ 3 C _ 1q were 34.9g / L and 16.3g / L, respectively. There were 15 cases with HBeAg positive serum and 25.9g / L with serum complement C _ 3 = 0.19 卤0.17g / l, and the deposition rate of complement C _ 3 C _ 1q in renal tissue was 80 ~ 46.7g / L, respectively. The difference between the two groups was statistically significant (P < 0.05) compared with that in the low-grade replication group for 24 hours (P < 0.05). Urine protein levels increased, The decrease of serum albumin level was found in the tubulointerstitium of group A and group B (P < 0.05). The number of CD25 T cells in Foxp3 lymphocytes was 3.41 卤1.16)vs(3.52 卤1.27 and 2.78 卤0.17 卤2.90 卤0.20 vs(3.09 卤0.18, respectively, which was significantly lower than that in group C (P < 0.05), and the number of CD25 T cells in group B was significantly lower than that in group C (P < 0.05), and the number of CD25 T cells in group A was significantly lower than that in group B (P < 0.05), and the number of CD25 T cells in group B was significantly lower than that in group C (P < 0.05). The difference was statistically significant (P < 0.05), and the expression of Foxp3 CD4 + CD25 in group A was lower than that in group B (P < 0.05). Conclusion HBV-GN is more common in males, and the main clinical manifestation is nephrotic syndrome. The pathological type of HBV-GN is mainly membranous nephropathy. There is a certain correlation between HBV-GN level and urinary protein and serum albumin levels in patients with membranous nephropathy. The activation of complement C3 and C1q may be involved in the pathogenesis of HBV-GN in serum HBeAg positive group. The down-regulation of Foxp3 expression on regulatory T cells may be related to the occurrence and development of HBV-associated glomerulonephritis.
【学位授予单位】：新疆医科大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R512.62;R692.3

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