發(fā)布時間：2018-05-11 02:15

  本文選題：乙型肝炎 + 腎小球腎炎��； 參考：《新疆醫(yī)科大學(xué)》2013年碩士論文

【摘要】：目的：探討我院近10年以來收集的乙肝相關(guān)性腎炎（HBV-GN）患者臨床及病理特征，提高診治水平；并分析叉狀頭/翅膀狀螺旋轉(zhuǎn)錄因子（Foxp3）在乙型肝炎病毒相關(guān)性腎炎（HBV-GN）腎組織中表達(dá)及其可能作用。方法：（1）收集并回顧性分析經(jīng)腎活檢確診為乙肝相關(guān)性腎炎58例患者臨床表現(xiàn)、實(shí)驗(yàn)室檢查指標(biāo)、腎活檢病理資料，記為A組；（2）選取同期行腎組織活檢、病例資料完整的52例腎組織活檢證實(shí)為腎炎但血清及腎組織中HBsAg均陰性，為非乙肝腎炎組，記為B組，24例患者血清HBsAg陽性、腎組織中HBsAg陰性，血清肌酐輕度升高經(jīng)腎組織活檢排除腎炎，為HBV感染組，記為C組。利用免疫組織化學(xué)法檢測三組患者腎組織Foxp3、CD4、CD25蛋白表達(dá)情況。結(jié)果：（1）乙肝相關(guān)性腎炎發(fā)病年齡集中在(26.7±10.3)歲；男女比例為（2.2:1）；臨床上以腎病綜合征為主要表現(xiàn)者27例（46.6%），腎炎綜合征者24例（41.4%），慢性腎功能不全占4例（6.9%），無癥狀性血尿或蛋白尿者3例（5.2%）；病理類型：膜性腎病占25例（43.1%），系膜增生性腎小球腎炎占16例（27.6%），膜增殖性腎小球腎炎占9例（15.5%），IgA腎病占6例（10.3%），硬化性腎小球腎炎占2例（3.4%）；血清HBeAg陰性組有43例（74.1%），血清補(bǔ)體C3水平為（0.99±0.27）g/l，，腎組織補(bǔ)體C3、C1q沉積率分別為34.9%、16.3%；血清HBeAg陽性組有15例（25.9%），血清補(bǔ)體C3水平為（0.19±0.17）g/l，腎組織補(bǔ)體C3、C1q沉積率分別為80%、46.7%，兩組比較差異均具有統(tǒng)計(jì)學(xué)意義(P＜0.05)；HBV DNA中度復(fù)制組較低度復(fù)制組24小時尿蛋白定量升高，血清白蛋白水平降低(P＜0.05)。（2）在A組與B組腎小管間質(zhì)中，每高倍鏡視野下Foxp3+淋巴細(xì)胞、CD4+T細(xì)胞、CD25+T細(xì)胞數(shù)分別為（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），均明顯低于C組Foxp3+淋巴細(xì)胞數(shù)、CD4~+T細(xì)胞、CD25+T細(xì)胞數(shù)（P均＜0.05）；A組與B組比較，差異有統(tǒng)計(jì)學(xué)意義（P＜0.05），且A組中Foxp3、CD4、CD25的表達(dá)低于B組。結(jié)論：（1）HBV-GN以男性多見，臨床以腎病綜合征為主要表現(xiàn)，病理類型以膜性腎病為主，HBV DNA水平與尿蛋白定量及血清白蛋白水平有一定相關(guān)性。補(bǔ)體C3及C1q的激活可能參與了血清HBeAg陽性組HBV-GN的發(fā)病機(jī)制；（2）調(diào)節(jié)性T細(xì)胞Foxp3表達(dá)水平的下調(diào)可能與乙肝相關(guān)性腎炎的發(fā)生發(fā)展有關(guān)。
[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 鹵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 鹵0.27 g / L, the complement of renal tissue was 0.99 鹵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 鹵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 鹵1.16)vs(3.52 鹵1.27 and 2.78 鹵0.17 鹵2.90 鹵0.20 vs(3.09 鹵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.
【學(xué)位授予單位】：新疆醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2013
【分類號】：R512.62;R692.3

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本文編號：1871959