摘要
目的分析儿童乙型肝炎病毒相关性肾炎(HBV-GN)的临床及病理特点,探讨不同方案治疗的疗效和预后。方法总结1998年1月至2006年6月在北京大学第一医院儿科就诊的42例HBV-GN患儿的临床及病理特点,并对不同治疗方案的疗效进行统计学分析。结果(1)平均起病年龄(7.7±2.1)岁,从起病到确诊的平均时间为(6.2±3.8)个月;男女比例5.0∶1;有HBV家族史者21例;24例临床为肾病综合征,9例为肾炎综合征,8例蛋白尿伴血尿,1例孤立性蛋白尿。(2)实验室检查:42例均有蛋白尿(其中肾病水平蛋白尿28例),36例有血尿;13例cCr>120mL/(min.1.73m2)。30例(71.4%)为HBsAg+HBeAg+HBcAb阳性,3例(7.1%)HB-sAg+HBsAb+HBcAb阳性;17例有ALT升高;在34例行HBV-DNA检测患儿中,27例(79.4%)HBV-DNA阳性。(3)非典型膜性肾病30例,轻到中度系膜增生肾小球肾炎7例(其中IgA肾病3例),毛细血管内增生性肾小球肾炎3例,FSGS1例,轻微病变1例;23例肾组织免疫荧光呈"满堂亮"。(4)单纯抗病毒治疗组(A组):16例,仅接受干扰素和(或)拉米夫定治疗;其中12例随访≥6个月,9例缓解,1例部分缓解,2例无效;6例HBeAg阴转。抗病毒联合激素及免疫抑制剂治疗组(B组):14例,在干扰素和(或)拉米夫定基础上联合激素及免疫抑制剂治疗;10例随访≥6个月,2例完全缓解,2例部分缓解,6例无效(2例有肾功能异常);2例HBeAg阴转。失访12例。在蛋白尿缓解方面,A、B两组之间差别有统计学意义,提示A组疗效优于B组;在HBeAg阴转方面两组间差别无统计学意义。结论乙型肝炎病毒相关性肾炎多为学龄儿童起病,男多于女;临床起病隐匿,多为肾病水平蛋白尿伴血尿;以非典型膜性肾病为主要病理表现,半数病例肾脏组织免疫荧光染色呈"满堂亮";单纯抗病毒治疗在蛋白尿缓解方面优于抗病毒联合激素及免疫抑制剂治疗;少数病例可进展为肾衰竭。
Objective To summarize the clinicopathological features of hepatitis B virus associated glomerulonephritis （ HBV-GN ） and the curative effect of different treatment. Methods A retrospective study was done on 42 children with HBV-GN from January 1998 to June 2006. Twenty-two cases who were followed up more than 6 months were performed statistical analysis. Results （ 1 ） The onset age was （ 7. 7 ± 2. 1 ） years and the interval between the onset and diagnosis was （6. 2 ±3.8） months. The ratio of male to female was 5： 1. Twenty-one had positive family history of HBV infection. The clinical diagnosis included nephrotic syndrome in 24, glolnerulonephritis in 9, proteinuria accompanied by hematuria in 8 and isolated proteinuria in 1. （ 2 ） Renal pathology ： there were 30 cases of membranous nephropathy （ MN ） among the 42 cases of HBV-GN ; 12 cases were other pathological patterns, including mesangial proliferative nephritis in 7 cases （ IgA nephropathy in 3 cases ） , endocapilary proliferative glomerulonephritis in 3 cases, FSGS in 1 case, minimal lesion nephropathy in 1 case;＂ full house＂ was confirmed in twenty-three cases. （3 ） Serum HBV：thirty patients （71.4% ） were HBsAg, HBeAg and HBcAb positive;3 eases （7.1%） were HBsAg,HBsAb and HBcAb positive;27 cases （79.4% ） were HBV-DNA positive;17 cases presented with high level of ALT. （4 ） Curative effect： in group A：16 were solely given antiviral therapy,including α-interferon （IFN-α） and/or lamivudine, aud 12 were followed up more than 6 months. Among these 12 patients, nine of them went into complete remission, one partial remission and two never remitted, six cleared HBeAg. In group B：14 were treated with antivirus combined with steroid and immunosuppressant, and 10 of them had been followed up more than 6 months. Among these 10 patients, two went into eompletely remission, two partial remission, six no effeet （two of them went into renal failure） ;two eleared HBeAg. Among all patients ,12 eases failed to be followed up. Group A was much better than Group B （ P 〈0. 05 ） in respeet to proteinuria remission. There was no statistie signifieanee in respeet to elearanee of serum HBeAg between the two groups. Conclusion HBV-GN frequently takes plaee in the sehool aged ehildren, male more than female;the onset is hidden, and most patients present with nephrotie level proteinuria aeeompanied with hematuria;MN is the most eommon renal pathological manifestation and immunofluoreseenee analysis shows ＂full house＂ in more than half of HBV-GN ehildren. The eurative effeet of sole antiviral therapy appears to be better than combination antiviral and immunosuppressive therapy regarding to proteinuria remission;a small part of HBV-GN patients still go into renal failure.
出处
《中国实用儿科杂志》
CSCD
北大核心
2008年第6期425-429,共5页
Chinese Journal of Practical Pediatrics
关键词
乙型肝炎病毒相关性肾炎
儿童
膜性肾病
Hepatitis B virus-assoeiated glomerulonephritis
Children
Membranous nephropathy
