本文關(guān)鍵詞：血清學(xué)陰性的乙型肝炎病毒相關(guān)性腎炎的臨床病理分析及治療　出處：《中國(guó)現(xiàn)代醫(yī)學(xué)雜志》2016年11期 　論文類型：期刊論文

  更多相關(guān)文章： 乙型肝炎病毒相關(guān)性腎炎 乙型肝炎病毒標(biāo)志物 病理 治療 他克莫司

【摘要】：目的探討血清學(xué)陰性的乙型肝炎病毒相關(guān)性腎炎(HBV-GN)的臨床病理特征及治療方案,評(píng)估他克莫司聯(lián)合激素治療的安全性及有效性。方法選取2009年1月-2012年9月該院其經(jīng)腎活檢診斷為HBVGN的患者,根據(jù)血清學(xué)特點(diǎn)選出HBV血清學(xué)陰性組患者20例,分析其臨床及病理特點(diǎn);將確診為腎病綜合征的17例患者分為兩組,拉米夫定聯(lián)合激素組(B組)和他克莫司聯(lián)合激素組(A組),比較兩種治療方案的療效,并定期監(jiān)測(cè)HBV血清學(xué)指標(biāo)及肝、腎功能等評(píng)價(jià)治療的安全性。結(jié)果 120例血清學(xué)陰性HBV-GN患者,男女比為1.86∶1.00,17例(85%)表現(xiàn)為腎病綜合征,3例(15%)表現(xiàn)為腎炎綜合征;血清HBsAg、HBeAg、HBsAb、HBeAb、HBcAb陰性,HBV-DNA陰性。2HBV-GN病理特點(diǎn)。a.光鏡100%表現(xiàn)為不典型膜性腎病(MN);免疫組織化學(xué)法檢查腎組織HBsAg、HBcAg和HBsAg+HBcAg陽(yáng)性率分別為90%(18/20)、40%(8/20)和30%(6/20)。免疫熒光多種免疫復(fù)合物多部位、高強(qiáng)度沉積。b.電鏡下電子致密物多部位沉積。3A組總有效率為100.0%,高于B組(12.5%)(P0.05);A組血清白蛋白(ALB)水平高于B組(P0.05),而A組24 h尿蛋白定量(UPRO)低于對(duì)照組(P0.05)。4兩組治療過(guò)程中無(wú)明顯不良反應(yīng)。結(jié)論 1血清學(xué)陰性HBV-GN以男性多見(jiàn),病理類型表現(xiàn)為不典型膜性腎病。血清學(xué)陰性HBV-GN患者拉米夫定+激素治療無(wú)效;FK506+激素治療所有患者均有效,并且不引起HBV活動(dòng)及肝腎功能異常。2建議對(duì)乙肝病毒血清學(xué)陰性的腎病綜合征或慢性腎炎綜合征患者,尤其病理表現(xiàn)為非典型膜性腎病的患者,腎活檢時(shí)應(yīng)常規(guī)行腎組織病理乙肝抗原檢測(cè),以免漏診HBV-GN。3他克莫司聯(lián)合激素是治療血清學(xué)陰性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.
【作者單位】： 南昌大學(xué)第一附屬醫(yī)院腎內(nèi)科;
【分類號(hào)】：R512.62;R692.3
【正文快照】： 乙型肝炎病毒相關(guān)性腎炎(hepatitis B virusassociated glomerulonephritis,HBV-GN)是指乙肝病毒(hepatitis B virus,HBV)直接或間接誘發(fā),經(jīng)血清免疫學(xué)及免疫組織化學(xué)法或免疫熒光證實(shí)并排除其他繼發(fā)性腎小球腎炎的一種腎小球腎炎。HBV血清學(xué)陰性的HBV-GN臨床報(bào)道不多,且治療

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