摘要
目的探讨肾穿刺确诊膜性肾病(membranous nephropathy,MN)合并HBV感染的病理特点及肾组织HBV抗原检测的意义。方法回顾性分析147例MN患者的临床和肾脏病理资料,根据HBV血清学结果分为A组(HBV抗原阳性)、B组(仅HBV抗体阳性)、C组(HBV阴性的原发MN),比较其肾脏病理、临床表现及实验室检测结果。肾组织HBsAg/HBcAg检测采用EnVision方法。结果 A组肾小球基膜假双轨、肾小球节段硬化、节段内皮细胞肿胀增生、内皮下和系膜区电子致密物及IgM、C4、C1q沉积的比率显著高于C组。A组的发病年龄较低,肝功能异常和低补体血症发生率明显高于B、C两组(P<0.05)。A组肾组织HBsAg和(或)HBcAg阳性患者在病理及临床表现方面与阴性患者比较无明显差异(P>0.05)。结论不同于原发性MN,伴HBV感染的MN常伴肾小球节段硬化、内皮细胞肿胀增生、假双轨和多种免疫球蛋白及补体多部位沉积。免疫组化未发现肾组织HBsAg和(或)HBcAg沉积不能完全排除MN与HBV感染不相关,还需结合光镜、荧光和电镜的改变综合判断。
Purpose To investigate the renal pathological features of biopsy-proved membranous nephropathy （MN） with hepatitis B virus（HBV） infection and the significance of HBV related antigens detection in kidney.Methods Retrospective analysis of clinicopathological features was conducted in 147 cases of MN,which were divided into group A （HBV antigens positive）,group B （only HBV antibodies positive） and group C （idiopathic MN with no HBV infection） according to serum markers of HBV.The renal pathological changes,clinical manifestations and laboratory results were compared.The depositions of HBsAg and HBcAg were detected by immunohistochemistry of EnVision method.Results The occurrence rate of duplication of glomerular basement membrane （GBM）,segmental endothelial cells proliferation,segmental glomerular sclerosis,dense deposition in subendothelial and mesangial region and depositions of IgM,C4 and C1q in glomeruli in group A was significantly higher than that in group C （P0.05）.The age onset in the group A was much younger,the ratio of hepatic insufficiency and hypocomplementemia was obviously higher than that in groups B and C （P0.05）.No significant differences were found in clinicopathological features between two groups with and without HBsAg and/or HBcAg deposition in kidney in group A.Conclusions Unlike idiopathic MN,MN with HBV infection commonly presents focal segmental sclerosis,endothelial cells proliferation,duplication of GBM and multiple immunoglobulins or complements deposition in glomeruli.Whether MN related to HBV infection or not can not only rely on the immunohistochemical detection of HBV antigens in renal tissue,but also on the histological changes under light,immunofluorescence and eletron microscopy.
出处
《临床与实验病理学杂志》
CAS
CSCD
北大核心
2010年第5期543-547,共5页
Chinese Journal of Clinical and Experimental Pathology
基金
国家自然科学基金(30871001)
上海市重点学科(T0201)
上海市卫生局重点学科(05Ⅲ001)
上海市科学技术委员会重点项目(08DZ1900502)
关键词
膜性肾病
肾脏病理
乙型肝炎病毒
membranous nephropathy
renal pathology
hepatitis B virus
