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1、83例儿童乙型肝炎病毒相关肾炎的临床病理研究刘志莹郑卫民彭晓杰江西省儿童医院肾内科X关注成功！加关注后您将方便地在我的关注中得到本文献的被引频次变化的通知！·新浪微博·腾讯微博·人人网·开心网·豆瓣网·网易微博摘 要：目的:探讨儿童乙型肝炎病毒相关肾炎的临床及病理特点。方法:收集83例经肾活检确诊为HBV-GN患儿入院时的临床症状(如浮肿、血压、血尿)及实验室检查结果(如尿常规、24h尿蛋白定量、乙肝五项、血白蛋白、血、尿HBV-DNA等)及肾脏病理检查结果(肾脏病理类型,免疫球蛋白、补体及HBsAg、HBcAg的沉积情况,肾小管、间质损害情况),并分
2、析比较不同肾间质损害HBV-GN患儿临床病理特点。结果:临床表现:单纯性血尿4例(4.8%);单纯性蛋白尿8例(9.6%);血尿和蛋白尿15例(18%);肾病综合征(NS)56例(67%)。病理类型:膜性肾病(MN)61例(73.4%),系膜增生性肾小球肾炎(MsPGN)13例(15.6%),膜增生性肾小球肾炎(MPGN)7例(8.4%),毛细血管内增生性肾小球肾炎(EnPGN)2例(2.4%)。HBV-GN患儿肾间质损害积分与血、尿HBV-DNA载量呈正相关(r血=0.827,P=0.000,r尿=0.836,P=0.000)。中重度损害组肾组织乙肝病毒标
3、志物以HBsAg、HBcAg同时沉积为主,且肾间质、肾小管上皮细胞都存在不同程度的乙肝病毒标志物沉积,而轻度损害组、无损害组以HBsAg沉积为主,且肾小管上皮细胞和肾间质很少有沉积。结论:儿童HBV-GN发病男高于女,学龄期儿童多见。临床类型以肾病综合征为主,病理类型以MN为主。血、尿HBV-DNA水平与HBV-GN患儿肾间质损害程度有关。关键词：乙型肝炎病毒相关肾炎;肾间质损害;乙肝病毒DNA;ClinicopathologicalStudyonHepatitisBVirus-AssociatedGlomerulonephritisin83Children
4、LIUZhi-yingZHENGWei-minPENGXiao-jieDepartermentofNephrology,JiangxiProvincialChildren'sHosptal;Abstract：Objective:ToexploreclinicopathologicalfeatureofHepatitisBVirus-associatedGlomerulonephritisinChildren.Methods:Clinicopathologicalfeatureof83childrenwithHBV-GNprovedbyrenalbiopsyw
5、ereanalyzed.Theclinicalmanifestation(edema,bloodpressureandhematuria)andlaboratoryexaminationdata(routineurianlysis,24hurinaryproteinexcretion,themarkerofHBVinfection,serumalbumn,theserumlevelofHBV-DNA,theurinarylevelofHBV-DNAandother)inpresentwererecorded.Pathologicaltypesandthede
6、positofimmunoglobulininrenaltissuewerealsorecorded.TorecordtubulointerstitiallesionsandthedepositofHBsAgandHBcAginrenaltissue.ToanalyseclinicopathologicalfeatureofHBV-GNwithdifferenttubulointerstitiallesions.Results:ThecommonestclinicalmanifestationofHBV-GNwasNephroticsyndrome(NS)(
7、56/83,67%),thesecondwashematuriawithproteinuria(15/83,18%).Proteinuriawithouthematuriawasfoundin8cases(9.6%),hematuriawithoutproteinuriawas4cases(4.8%).MNwastheprominentpathologicaltypes(61/83,73.4%),followedbyMsPGN(13/83,15.6%)andMPGN(7/83,8.4%),EnPGNwastherarest(2/83,2.4%).Thelev
8、eloftubulointerstitiallesi
