血清学阴性的乙型肝炎病毒相关性肾炎的临床病理分析及治疗

发布时间：2017-12-31 04:07

  本文关键词：血清学阴性的乙型肝炎病毒相关性肾炎的临床病理分析及治疗　出处：《中国现代医学杂志》2016年11期 　论文类型：期刊论文

  更多相关文章： 乙型肝炎病毒相关性肾炎 乙型肝炎病毒标志物 病理 治疗 他克莫司

【摘要】：目的探讨血清学阴性的乙型肝炎病毒相关性肾炎(HBV-GN)的临床病理特征及治疗方案,评估他克莫司联合激素治疗的安全性及有效性。方法选取2009年1月-2012年9月该院其经肾活检诊断为HBVGN的患者,根据血清学特点选出HBV血清学阴性组患者20例,分析其临床及病理特点;将确诊为肾病综合征的17例患者分为两组,拉米夫定联合激素组(B组)和他克莫司联合激素组(A组),比较两种治疗方案的疗效,并定期监测HBV血清学指标及肝、肾功能等评价治疗的安全性。结果 120例血清学阴性HBV-GN患者,男女比为1.86∶1.00,17例(85%)表现为肾病综合征,3例(15%)表现为肾炎综合征;血清HBsAg、HBeAg、HBsAb、HBeAb、HBcAb阴性,HBV-DNA阴性。2HBV-GN病理特点。a.光镜100%表现为不典型膜性肾病(MN);免疫组织化学法检查肾组织HBsAg、HBcAg和HBsAg+HBcAg阳性率分别为90%(18/20)、40%(8/20)和30%(6/20)。免疫荧光多种免疫复合物多部位、高强度沉积。b.电镜下电子致密物多部位沉积。3A组总有效率为100.0%,高于B组(12.5%)(P0.05);A组血清白蛋白(ALB)水平高于B组(P0.05),而A组24 h尿蛋白定量(UPRO)低于对照组(P0.05)。4两组治疗过程中无明显不良反应。结论 1血清学阴性HBV-GN以男性多见,病理类型表现为不典型膜性肾病。血清学阴性HBV-GN患者拉米夫定+激素治疗无效;FK506+激素治疗所有患者均有效,并且不引起HBV活动及肝肾功能异常。2建议对乙肝病毒血清学阴性的肾病综合征或慢性肾炎综合征患者,尤其病理表现为非典型膜性肾病的患者,肾活检时应常规行肾组织病理乙肝抗原检测,以免漏诊HBV-GN。3他克莫司联合激素是治疗血清学阴性HBV-GN的安全、有效方法之一。
[Abstract]:Objective to investigate the clinicopathological features and treatment of hepatitis B virus associated glomerulonephritis (HBV-GNN) with sero-negative. To evaluate the safety and efficacy of tacrolimus combined with hormone therapy. Methods the patients with HBVGN diagnosed by renal biopsy from January 2009 to September 2012 were selected. According to the serological characteristics, 20 patients with HBV sero-negative group were selected and their clinical and pathological features were analyzed. Seventeen patients with nephrotic syndrome were divided into two groups: lamivudine combined with steroid group (group B) and tacrolimus combined with hormone group (group A). The HBV serological index and liver and renal function were regularly monitored to evaluate the safety of the treatment. Results the ratio of male to female was 1.86: 1.00 in 120 patients with sero-negative HBV-GN. There were 17 cases with nephrotic syndrome and 3 cases with nephritis syndrome. Serum HBcAb of HBeAg was negative. The pathological features of HBV-DNA negative. 2HBV-GN. Light microscope 100% showed atypical membranous nephropathy. The positive rates of HBcAg and HBsAg HBcAg in renal tissues detected by immunohistochemical method were 90 / 18 / 20 respectively. 40 / 8 / 20) and 30 / 20 / 20. Immunofluorescence multiple immune complexes. Under electron microscope, the total effective rate of group 3A was 100.0, which was higher than that of group B (12.5p 0.05). The level of serum albumin in group A was higher than that in group B (P 0.05). However, there was no significant adverse reaction in group A (24 h urinary protein quantification) compared with control group (P0.05.4). Conclusion (1) serologically negative HBV-GN is more common in men. The pathological type was atypical membranous nephropathy. Lamivudine was ineffective in sero-negative HBV-GN patients. FK506 hormone is effective in all patients and does not cause abnormal HBV activity and liver and kidney function. 2. It is recommended for patients with HBV sero-negative nephrotic syndrome or chronic nephritis syndrome. Especially in patients with atypical membranous nephropathy, the pathological hepatitis B antigen should be detected by routine renal biopsy. To avoid misdiagnosis of HBV-GN.3 tacrolimus combined with hormone is one of the safe and effective methods for sero-negative HBV-GN.
【作者单位】： 南昌大学第一附属医院肾内科;
【分类号】：R512.62;R692.3
【正文快照】： 乙型肝炎病毒相关性肾炎(hepatitis B virusassociated glomerulonephritis,HBV-GN)是指乙肝病毒(hepatitis B virus,HBV)直接或间接诱发,经血清免疫学及免疫组织化学法或免疫荧光证实并排除其他继发性肾小球肾炎的一种肾小球肾炎。HBV血清学阴性的HBV-GN临床报道不多,且治疗

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