乙型肝炎病毒相关性膜性肾病、特发性膜性肾病和狼疮膜性肾病的临床和病理特征

摘要

目的 比较乙型肝炎病毒相关膜性肾病(HBV-MN)、特发性膜性肾病(IMN)和狼疮膜性肾病(LMN)的临床和病理学特点.方法 根据临床诊断将肾活检的成人患者分为HBV-MN组(48例)、IMN组(100例)和LMN组(31例).回顾性分析各组的临床表现和病理学特点;用免疫组化法对部分病理肾活检行IgG亚型染色,半定量分析染色强度.结果 (1) HBV-MN组发病年龄介于LMN和IMN组之间,男性居多;LMN组女性患者居多.HBV- MN和LMN组血清补体下降显著高于IMN组.(2) HBV-MN组和LMN组系膜增生、系膜区及内皮下电子致密物出现的百分比均高于IMN组.(3)HBV-MN、IMN和LMN组IgG4占优势的百分比分别为64.7%、60.9%和9.5%,IgG3占优势的百分比分别为0、8.7%和42.9%(P<0.01).结论 HBV- MN组临床表现、病理特点与LMN组具有相似性;但其肾小球IgG亚型沉积特点与IMN相近.%Objective To compare the clinical and pathological features of hepatitis-b virus associated membranous nephropathy (HBV-MN), idiopathic membranous nephropathy (IMN) and lupus membranous nephropathy (LMN).Methods On the basis of kidney biopsy, 179 adult inpatients were divided into three groups of HBV-MN(48 cases),IMN(100 cases) and LMN(31 cases).Data of clinical and pathogenic characters were analyzed retrospectively, which included IgG subtype antibodies staining with immunohistochemical method and semiquantitatively analyzing the intensity.Results Age of onset was in an order of group LMN＞ HBV-MN＞IMN.The majority of patients in group HBV-MN were male and those of group LMN were female.The decrease of serum complements was greater in groups of HBV-MN and LMN than that in group IMN.Percentages of mesenterial hyperplasy, digital dense material of mesenterial and subendothelial area were greater in groups of HBV-MN and LMN than those in group IMN.Percentages of IgG4 priority for groups of HBV-MN,IMN and LMN were 64.7 ％, 60.9 ％ and 9.5 ％, respectively, which of IgG3 were 0,8.7 ％ and 42.9％(P＜0.01).Conclusion Clinical and pathogenic characters of HBV-MN are similar to those of group LMN, but the prior sedimentation of IgG subtypes of glomerulus of group HBV-MN is close to that of group IMN.