HBeAg阳性和阴性乙型肝炎病毒相关性肾炎相关因素的对比分析

摘要

Objective To explore and compare the clinical, pathological and antiviral efficacy features of HBeAg-positive and negative hepatitis B virus associated glomerulonephritis (HBV-GN). Methods 98 cases of HBV-GN patients were divided into HBeAg positive group (52 cases) and HBeAg-negative group (46 cases), and the clinical, pathological and antiviral efficacy of the two groups were compared. Results Kidney disease onset age, the proportion of male patients and the proportion of patients with cirrhosis were significantly lower in the HBeAg positive group than in HBeAg negative group (P < 0.05). Treatment regimen of 48 weeks of Lamivudine was adopted in both groups. Cirrhosis, child-pugh scores, pro-thrombin activity (PTA) and the proportion of hematuria before treatment, and urine protein, serum creatinine, serum albumin, alanine amino-aminotransferase (ALT) and renal biopsy pathology results 24-hours after treatment were not significantly different in the two groups (P > 0.05). During the time between end of treatment and 24 weeks of outpatient follow-up, 24-hour urine protein, level of ALT and HBVDNA and serum creatinine in both groups were found to be significantly lower compared with those before treatment, while serum albumin level were found to be significantly higher (P < 0.05). Mutation rate of tyrosine-methionine-aspartate-aspartate (YMDD) was 25.0% in the HBeAg-positive group, significantly higher than the 6.5% of the HBeAg negative group (P < 0.05). There were totally 24 cases of recurrence, with a recurrence rate of 24.49%. And the HBeAg-positive group had 4 cases (7.69%) of recurrence, while HBeAg-negative group had 20 cases (43.48%) of recurrence, indicating significant difference in recurrence rate between the two groups. Conclusion There are both similarities and differences between the HBeAg-positive and HBeAg-negative HBV-GN groups in their correlative factors also have a different point. Thus to improve the diagnosis and treatment of HBV-GN, it is important to understand the differences and similarities between the two subtypes.%目的 比较HBeAg阳性和阴性乙型肝炎病毒相关性肾炎(HBV-GN)的临床、病理及抗病毒疗效的特点,探讨二者之间的异同.方法 将98例HBV-GN患者分为HBeAg阳性组(52例)与HBeAg阴性组(46例),并对其临床、病理及抗病毒疗效进行对照分析.结果 HBeAg阳性组患者肾病发病年龄,男性患者所占的比例、肝硬化患者所占的比例均低于HBeAg阴性组,差异有统计学意义(P ＜ 0.05),以拉米夫定为主的48周治疗方案治疗两组患者,治疗前两组患者的肝硬化、Child-Pugh积分、凝血酶原活动度(PTA),血尿比例,24 h尿蛋白、血肌酐、血清白蛋白、丙氨酸氨基转移酶(ALT)以及肾穿刺活检病理检查结果,经比较差异无统计学意义(P ＞ 0.05),48周疗程结束后到门诊随访24周时发现,两组24 h尿蛋白,ALT及HBVDNA水平,血肌酐均较治疗前下降,血清白蛋白水平较治疗前上升,差异有统计学意义(P ＜ 0.05).HBeAg阳性组乙型肝炎病毒酪氨酸-蛋氨酸-天冬氨酸-天冬氨酸(YMDD)变异的发生率为25.0%,高于HBeAg阴性组的6.5%(P ＜ 0.05).两组共有24例患者复发,复发率为24.49%,其中HBeAg阳性组有4例(7.69%)、HBeAg阴性组有20例(43.48%),差异有统计学意义.结论 HBeAg阳性HBV-GN与HBeAg阴性HBV-GN相关因素中既有共同点也有不同点,了解两者的异同,有助于提高HBV-GN的诊治水平.