乙肝病毒相关性肾炎的临床病理和治疗分析-论文.pdf

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1、·554·}缶床肾脏病杂志2013年12月第13卷第12期JClinNephrol，December2013，Vo1．13，No．12·论著·乙肝病毒相关性肾炎的临床病理和治疗分析刘俊兰凌毅生关天俊【摘要】目的分析乙肝病毒相关性肾炎的临床、实验室指标、病理特点及抗病毒治疗的疗效。方法对53例乙肝病毒相关性肾炎患者临床表现、肝功能、肾功能、乙肝病毒血清标志物、乙肝病毒DNA以及病理分型进行分析，观察乙肝病毒DNA与临床表现之间的相关性，并根据乙肝病毒复制情况和蛋白尿的水平进行分组，给予核苷类似物抗病毒治疗，观察治疗效果。结果肾病综合征21例，肾炎综合征32例，48

2、例患者合并血尿，合并肾功能不全患者3例。肾活检病理结果显示膜性肾病占49．06，膜增生性。肾小球肾炎占3()．19，继发性IgA肾病占2O．75。乙肝病毒DNA载量与24h尿蛋白定量呈正相关。19例患者使用核苷(酸)类似物拉米夫定和恩替卡韦抗病毒治疗6个月，乙肝病毒DNA载量显著下降，乙肝病毒相关性‘肾炎完全缓解2例，部分缓解6例。结论乙肝病毒相关性肾炎具有特殊临床表现与肾脏病理特征，乙肝病毒DNA载量与蛋白尿水平呈正相关。抗病毒治疗可在部分患者中获得完全和部分缓解。【关键词】乙肝病毒；血尿；治疗Clinicalandpathologiccharacterist

3、icsofhepatitisBvirus-associatedglomerulonephritisandthecurativeeffectofantiviraitherapyLIUJun-lan，LINGYi—sheng，GUANTian-jbtn．DepartmentofNeph—rology，ZhongshanHospitalAffiliatedtoXiamenUniversity，Xiamen3610{)4，China[Abstract]ObjectiveToanalyzetheclinicalandpathologiccharacteristicsofh

4、epatitisBvirus(HBV)一associatedglomerulonephritisandthecurativeeffectofantivira1therapy．MethodsFifty-threecasesofHBV-associatednephritiswereenrolledinthisstudy．Weobservedtheclinica1manifestationsandpathologicalclassificationsofthesepatients，andstudiedtherelationshipbetweenHBV-DNArepli

5、—cationlevelandclinicalmanifestations．Specialantiviraltreatmentsweregivenaccordingtothesitua—tionofHBVreplicationandthelevelofproteinuria，andthecurativeeffectswereobserved．ResultsTherewere21casesofnephroticsyndrome，32casesofnephritissyndrome，48casesofhematuria，and3casesofrenalinsuffi

6、ciency．Renalbiopsypathologyresultsshowedthatthemembranousnephropathyaccountedfor49．06％，membraneproliferativeglomerulonephritisfor30．19，andsecondaryIgAne—phropathyfor20．75．HBV-DNAreplicationlevelswerepositivelycorrelatedwith24一hurinarypro—teinlevels．After6-monthantiviraltreatmenton19c

7、ases，2casesobtainedcompleteremission，and6casesobtainedpartialremission．ConclusionsTheHBV-associatedglomerulonephritishasspecialclin～icalmanifestationsandpathologicalcharacteristics．Antiviraltreatmentcanobtaincompleteandpartialresponseinsomepatients．[KeywordslHepatitisBvirus；Hematuria

8、；Treatment我国