| Objectives:Discuss the pathological and clinical characteristics of hepatitis B virus-associated glomerulonephritis to provide an idea for clinical treatment and prognosis.Methods:A retrospective analysis is used for the data of 83 cases with hepatitis B virus-associated glomerulonephritis diagnosed by renal biopsy in the First Hospital of Jilin University from October 2010 to October 2016.All patients’ diagnosis are in accordance with the criteria which is proposed by Beijing Symposium in 1989,the general clinical and laboratory results are complete as well.SPSS22.0 software is used for statistical analysis.Results:1.There are 3248 patients received renal biopsy from October 2010 to October 2016 in the First Hospital of Jilin University.83 cases are diagnosed with hepatitis B virus-associated glomerulonephritis,which accounts for 2.56% of the same term of renal biopsy.2.The male/female ratio of HBV-GN is 2.07:1,the average incidence age of the patients with HBV-GN is 44.30±15.92 years old.Clinical manifestation of nephrotic syndrome is found in 63 cases(75.9%).Denying history of hepatitis B and regonizing initial renal disease is found in 58cases(69.88%).All negative markers of viral B in serum is found in 11 cases(13.25%).Membranous nephropathy is found in 76 cases(91.57%),of which atypical membranous nephropathy is found in 31 cases(40.79%).Pathological type of membranous proliferative glomerulonephritis is found in 2 cases(2.41%).Pathological type of Ig A nephropathy is found in 5 cases(6.02%).There are many kinds of immunoglobulin and complement deposition can be seen in the immunofluorescence,among which 19 cases(22.89%)showed total brightly.Vital B antigen deposition is found in all immunofluorescence,among which 52 cases(62.65%)is found with antigen of HBs,HBe,HBc deposition.3.There are 76 patients diagnosed with hepatitis B virus-associated membranous nephropathy(HBV-MN),among which clinical manifestation of nephrotic syndrome is found in 62 cases(81.59%),clinical manifestation of non-nephrotic syndrome is found in 14 cases(18.42%).There are no statistical signficant difference between the two groups in sex,age,course of disease,hematuria,systolic and diastolic pressure.Patients with nephrotic syndrome had higher level of edema(p<0.01),cholesterol and triglyceride(p<0.05),but lower level of serum albumin,total bilirubin,direct bilirubin,indirect bilirubin(p<0.01)and aspartic aminotransferase(AST)(p<0.05).The serum creatinine urea nitrogen is similar between the two groups and has no statistical significance.4.Among the 83 patients with HBV-GN,24 cases(28.92%)had a higher level of hepatitis B virus quantity more than 103,including 18 cases’(75%)pathological presentation indicating HBV-MN,8 cases’(44.44%)pathological presentation indicating atypical membranous nephropathy,2 cases(8.33%)indicating HBV-MPGN and 4 cases(16.7%)indicating Ig A nephropathy.59 cases(71.08%)among the 83 patients with HBV-GN had a lower level of hepatitis B virus quantity than 103,including 58 cases’(98.31%)pathological presentation indicating HBV-MN,23 cases’(39.66%)pathological presentation indicating atypical membranous nephropathy,1 cases(1.69%)indicating Ig A nephropathy.The difference of the two groups pathological presentation had no statistics significance in the deposition of HBs Ag,HBs Ag+HBc Ag,HBc Ag.The positive depositions of HBs Ag+HBe Ag are only found in the patients with a higher level of hepatitis B virus quantity,difference among them is statistical significant(p<0.05).The positive depositions of HBs Ag+HBe Ag+HBc Ag are only found in the patents with a lower level of hepatitis B virus quantity,difference among them is statistical significant(p<0.01).Patients with hepatitis B virus quantity more than 103 had higher level of serum creatinine,urea nitrogen,ALT,AST(p<0.05).Patients with hepatitis B virus quantity less than 103 had a higher level of urine protein quantitation in 24 hours,complement C3,C4(p<0.05).The difference between the two groups in glomerular filtration rate and plasma albumin have no statistical signi-ficance.5.83 patients diagnosed with HBV-GN are separated into four groupsaccording to the different treatment,i.e.,Symptomatic treatment group of 17 cases;Antiviral treatment group of20 cases;immunosuppressive treatment group of 28 cases;Antiviral combined immunosuppressive treat-ment group of 17 cases.Followed up for 6 months,we analyzed different viral load in patients with therapeutic effect.Forpatients with high viral load,response rate of antivirus combined immuno-suppression group is obviously higher than that of antiviral group.For the patients with a low viral load,antiviral treatment has the highest response rate,the total res-ponse rate symptomatic treatment group is the lowest.Six months afer treatment,all patients’ liver function returned to normal level,hepatitis B viral load decreased,renal function of five patients are deteriorated which accounts for 6.02%.One patient’s renal function improved significantly,the rest patients’ renal function are basically stable.Conclusions:1.In this research,middle-aged people is the prone group with HBV-GN,especially common for the midlle-aged men.Nephrotic syndrome is the major clinical manifestation and HBV-MN is the most common pathological type.The deposition of various immune markers can be seen under the immunofluorescence.Few patients have total negative markers of viral B in serum,but the HBV antigens also deposit in the kidney tissues.2.The HBV-GN patients with high viral load suffer from the severely damage of liver-renal function.The different viral load has no influence on renal pathology.Low viral load patients of HBV-GN have a higher level of urine protein quantity in 24 hours.3.Compared to single antiviral,for HBV-GN patients with high viral load,the remission rate of antiviral combined immune suppressive therapy is higher.For patients with low viral load,antiviral treatment has the highest remission rate.Antiviral treatment has exact curative effect in reducing proteinuria and delaying the progress of the kidney.A small number of HBV-GN patients’ renal function continue to progress. |
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