呈肾病综合征的乙型肝炎病毒相关性肾炎临床病理特点

摘要

目的:探讨呈肾病综合征(NS)的乙型肝炎病毒相关性肾炎(hepatitis B virus-associated glomerulonephritis,HBV-GN)的临床病理特点.方法:回顾性分析呈NS且肾穿组织内小动脉≥5条的HBV-GN患者152例的临床病理资料,光镜下观察其肾内小动脉病变,比较伴与不伴肾内小动脉病变患者的临床病理资料.结果:平均年龄26.3岁,男:女为3.6:1;伴高血压者36例(23.7%)、贫血52例(34.2%)、肾衰竭者33例(21.7%)、肝功能异常者20例(13.2%).乙肝大三阳者87例(57.2%);血清和肾组织内HBV-DNA载量呈正相关(P＜0.01).病理表现以膜性肾性(MN)、系膜增生性肾炎(MsPGN)、膜增生性肾炎(MPGN)为主;未成年组与成年组MN、MPGN所占比例不同(P＜0.05).伴有肾内小动脉病变者84例(55.2%),与无肾内小动脉病变者相比,其高血压发生率较高(P＜0.05),24 h尿蛋白定量显著较高(P＜0.01),贫血、肾间质纤维化的发生率显著较高(P＜0.01).结论:呈NS的HBV-GN患者绝大多数为HBV携带者且伴有病毒复制,病理以MN、MsPGN及MPGN为主,半数以上伴有肾内小动脉病变,伴有肾内小血管病变者高血压、贫血及肾小管间质纤维化发生率较高,蛋白尿更严重,为预后不良的病理学指标.%Objective:To Investigate the clinicopathological features of hepatitis B virus -associated glomerulonephritis patients with nephrotic syndrome. Methods:The clinical and pathological data of 152 cases with nephrotic syndrome and renal biopsy tissue small artery cross - sectional ≥ 5 of HBV - GN were analyzed retrospectively. Small intrarenal arterial lesions( SRAL ) were observed, and the clinical and pathological data in patients with or without SRAL were compared. Results: Among them, there was a 3. 6:1 predominance of males, mean age was 26. 3 years,36( 23. 7% ) patients broken out with hypertension, 52( 34. 2% ) with anemia, 33( 21. 7% ) suffered renal dysfunction, 20( 13. 2% ) liver function were impaired, 87( 57. 2% ) serum HBsAg,HBeAg,HBcAb were all positive. With the rising of the content of HBV - DNA in serum,it increases in renal biopsy tissue ( P < 0. 01 ). The MN, MsPGN, MPGN were common renal histological types. 84(55.2% ) of patients had SRAL. The incidence of hypertension, anemia and renal tubulointerstitial fibrosis in patients with SRAL were higher than that in patients without SRAL ( P < 0. 05 ). The patients with SRAL had a higher urinary protein level. Conclusion: The most patients of HBV - GN with nephrotic syndrome are HBV earners. Renal histological consists of many types, MN is the most common type. SRAL have a close relationship with hypertension, anemia and tubulointerstitial fibrosis, that suggest SRAL indicate a poor prognosis of those patients.