论文部分内容阅读
目的探讨青年、中年和老年乙型肝炎(乙肝)病毒(HBV)相关性肾炎(hepatitis B virus associated glomerulonephritis,HBV-GN)患者的临床表现和肾脏病理特点。方法回顾分析2009年1月~2015年10月在中日友好医院经肾活检证实的560例乙型肝炎病毒相关膜性肾病(hepatitis B virus associated membranous nephropathy,HBV-MN)患者的临床表现及病理特点。根据年龄将患者分为青年组(≤44岁)、中年组(45~59岁)和老年组(≥60岁),对比分析3组患者之间的临床表现、乙肝血清学标记物及病理特点等。结果青年组247例,中年组193例,老年组120例。三组均以肾病综合征为主要临床表现。老年组肾功能状况方面[血肌酐、肾小球滤过率(eGFR)]明显差于青年组及中年组(P<0.01);老年组高血压发生率明显高于青年、中年组(P<0.01)。病理类型方面,老年组膜性肾病合并缺血性肾损伤及间质小管损伤的发生率明显高于青年组(P<0.01)。血清乙肝标记物方面,全阴性占总人数的43.8%(245/560),HBV感染者占7.0%(39/560)[“大三阳”(HBsAg、HBeAg、抗-HBc阳性)占3.4%,“小三阳”(HBsAg、抗-HBe、抗-HBc阳性)占3.6%]。结论 HBV-MN多见于中青年组,中老年组病理合并缺血性肾损伤或小管间质损伤的患者肾功能明显减退。临床对于怀疑膜性肾病的患者,即使乙肝血清学标记物为全阴性,也应进行肾活检及HBV抗原的免疫荧光染色,以提高HBV-MN的检出率。
Objective To investigate the clinical manifestations and renal pathological features of young, middle-aged and elderly patients with hepatitis B virus associated glomerulonephritis (HBV-GN). Methods The clinical manifestations and pathology of 560 patients with hepatitis B virus associated membranous nephropathy (HBV-MN) confirmed by renal biopsy from January 2009 to October 2015 in China-Japan Friendship Hospital were analyzed retrospectively. Features. The patients were divided into young group (≤44 years old), middle aged group (45 ~ 59 years old) and elderly group (≥60 years old) according to age. The clinical manifestations, serological markers and pathological changes of hepatitis B Features and more. Results There were 247 cases in youth group, 193 cases in middle age group and 120 cases in elderly group. The three groups were nephrotic syndrome as the main clinical manifestations. Serum creatinine and glomerular filtration rate (eGFR) in the elderly group were significantly lower than those in the young and middle-aged groups (P <0.01). The incidence of hypertension in the elderly group was significantly higher than that in the young and middle-aged patients P <0.01). Pathological types, the incidence of membranous nephropathy with ischemic renal injury and interstitial tubule injury in the elderly group was significantly higher than that in the youth group (P <0.01). In terms of serum hepatitis B markers, all negatives accounted for 43.8% (245/560) of the total number and HBV infection accounted for 7.0% (39/560) [ “Big Sanyang” (HBsAg, HBeAg, anti-HBc positive) 3.4%, “Small Sanyang” (HBsAg, anti-HBe, anti-HBc positive) accounted for 3.6%]. Conclusions HBV-MN is more common in young and middle-aged patients. The renal function of patients with pathological changes of ischemic kidney injury or tubulointerstitial injury in middle-aged and elderly patients is obviously decreased. Clinical For patients suspected of membranous nephropathy, even if the hepatitis B serological markers are all negative, should also be performed renal biopsy and immunofluorescence staining of HBV antigens to improve the detection rate of HBV-MN.