CAJ | 학술논문

目的探讨乙型肝炎病毒(HBV)基因型与儿童HBV相关性肾炎(HBV-GN)的关系.方法研究对象为HBV-DNA阳性乙型肝炎患儿176例,均进行基因分型、同时检测肝肾功、HBV-DNA载量.对发生HBV-GN的23例患儿进行肾脏穿刺活检.结果 176例乙型肝炎患儿中,C基因型患儿85例(48.3％),B基因型72例(40.9％),合计157例纳入研究.研究显示,HBeAg阳性患儿发生HBV-GN的比率(78.3％)要显著高于HBeAg阴性组(21.7％)(x2=18.301,P值＜0.001).C基因型患儿发生血尿、蛋白尿的比率(20.0％,18.8％)显著高于B基因型患儿(8.3％,5.6％)(x2=4.243,P =0.039;x2 =6.173,P=0.013),且丙氨酸氨基转移酶和补体C3的异常发生率在C基因型组( 10.2％,15.3％)亦显著高于B基因型组患儿(2.8％,2.8％)(x2=7.985,P=0.005；x2=7.067,P=0.008).HBV-DNA高载量患儿中C基因型患儿比例(79.2％)显著高于B基因型患儿(20.8％)(x2=35.514,P=0.000).结论甘肃地区儿童HBV基因型以C、B基因型为主,以C基因型为优势.C基因型患儿更易发生血尿、蛋白尿等肾脏损害表现.HBV-DNA的高载量可能与HBV-GN的发生有关.C基因型患儿DNA高载量发生几率显著升高可能是其更易发生HBV-GN的因素之一.
목적 탐토을형간염병독(HBV)기인형여인동HBV상관성신염(HBV-GN)적관계.방법 연구대상위HBV-DNA양성을형간염환인176례,균진행기인분형、동시검측간신공、HBV-DNA재량.대발생HBV-GN적23례환인진행신장천자활검.결과 176례을형간염환인중,C기인형환인85례(48.3％),B기인형72례(40.9％),합계157례납입연구.연구현시,HBeAg양성환인발생HBV-GN적비솔(78.3％)요현저고우HBeAg음성조(21.7％)(x2=18.301,P치＜0.001).C기인형환인발생혈뇨、단백뇨적비솔(20.0％,18.8％)현저고우B기인형환인(8.3％,5.6％)(x2=4.243,P =0.039;x2 =6.173,P=0.013),차병안산안기전이매화보체C3적이상발생솔재C기인형조( 10.2％,15.3％)역현저고우B기인형조환인(2.8％,2.8％)(x2=7.985,P=0.005；x2=7.067,P=0.008).HBV-DNA고재량환인중C기인형환인비례(79.2％)현저고우B기인형환인(20.8％)(x2=35.514,P=0.000).결론 감숙지구인동HBV기인형이C、B기인형위주,이C기인형위우세.C기인형환인경역발생혈뇨、단백뇨등신장손해표현.HBV-DNA적고재량가능여HBV-GN적발생유관.C기인형환인DNA고재량발생궤솔현저승고가능시기경역발생HBV-GN적인소지일.
Objective To investigate the relationship between genotype of hepatitis B virus and hepatitis B virus related-glomerular nephritis in ( HBV-GN ) children.Method Totally 176 HBV-DNA positive children with chronic hepatitis B were randomly collected.Among the 176 patients,92 were HBV carriers,84 were cases with chronic hepatitis.The genotypes of their serum HBV,liver function,and HBV- DNA load were detected.When children showed nephrotic syndrome,renal biopsy was performed.Result Of the serum samples of 176 cases,85 (48.3％ ) were genotype C,72 (40.9％ ) were genotype B,13 (7.4％) were genotype B/C,and 6 (3.4％) were non-B/C genotype which were excluded.Among the analyzed 157 cases,the ratio of HBV-GN in the HBeAg positive group (78.3％) was significantly higher than that in the negative group ( 21.7％ ) ( x2 =18.301,P ＜ 0.001 ).And,the ratio of HBV-GN in the genotype C group ( 73.9％ ) was significantly higher than that in the genotype B group ( 26.1％ ) ( P ＜ 0.039).The ratio of hematuria or proteinuria in the genotype C group ( 20％,18.8％ ) was significantly higher than that in the genotype B group(8.3％,5.6％) (P ＜0.039; P value =0.013); and the alteration of ALT or C3 in the genotype C group ( 10.2％,15.3％ ) was more frequent than those in the genotype B group ( 2.8％,2.8％ ) ( P =0.005 ; P =0.008 ).There were no significant differences in kidney dysfunction or hepatomegaly.Further,the ratio of HBV-GN was more significantly frequent in HBV-DNA highly loading group (79.2％ ) than which in HBV-DNA lowly loading group (20.8％ ) ( P =0.000).Finally,in HBV-GN group,genotype C cases (88.2％ ) more frequently had high HBV-DNA load condition than genotype B cases (11.8％) (P =0.021 ).Conclusion Children with HBV infection in Gansu province showed mainly genotypes C or B,while genotype C seemingly predominant.Patients with genotype C more frequently showed proteinuria or hematuria.The high HBV-DNA load may be related with HBV-GN.It is a potential reason in the mechanism of HBV-GN that patients with genotype C had more possibility to have HBV-DNA high load.Analysis of HBV genotype for HBV patients maybe helpful in diagnosis and treatment.