CAJ | 학술논문

目的：回顾性分析儿童血清学阴性乙型肝炎病毒相关性肾炎（ sn HBV-GN）的临床及病理学特征，并初步探讨免疫抑制剂治疗的安全性和有效性。方法收集2006年1月至2011年12月经首都医科大学附属北京儿童医院肾活检诊断为HBV-GN病例，根据血清学结果筛选出HBsAg和HBV-DNA阴性患儿，分析其临床、病理资料和治疗情况。结果13例sn HBV-GN患儿进入分析，男8例，女5例，平均年龄11.8岁。临床表现以肾病综合征为主（11例），9例伴有血尿；2例表现为肾炎综合征。①11例以不典型膜性肾病为主要病理表现，免疫荧光以IgG、C3沉积为主，亦可见IgA、IgM、C1q沉积。②肾组织HBsAg与HBcAg阳性率分别为100％（13/13）和76.9％（10/13），强阳性率分别为23.1％（3/13）和15.4％（2/13）。③2例肾炎综合征患儿经抗凝和卡托普利治疗完全缓解；11例肾病综合征患儿，单纯抗病毒治疗2例均未缓解；单纯糖皮质激素治疗2/3例部分缓解，糖皮质激素加环孢素治疗2/3例部分缓解，糖皮质激素加用麦考酚酸酯治疗3例均完全缓解。加用免疫抑制剂患儿均未发现肝功能异常及HBV-DNA活动表现。结论儿童sn HBV-GN的病理以不典型膜性肾病为主要表现；免疫荧光显示免疫复合物的种类少，沉积强度低；麦考酚酸酯联合激素治疗较单用激素或激素联合环孢素治疗可能有效，单纯抗病毒治疗可能无效。
목적：회고성분석인동혈청학음성을형간염병독상관성신염（ sn HBV-GN）적림상급병이학특정，병초보탐토면역억제제치료적안전성화유효성。방법수집2006년1월지2011년12월경수도의과대학부속북경인동의원신활검진단위HBV-GN병례，근거혈청학결과사선출HBsAg화HBV-DNA음성환인，분석기림상、병리자료화치료정황。결과13례sn HBV-GN환인진입분석，남8례，녀5례，평균년령11.8세。림상표현이신병종합정위주（11례），9례반유혈뇨；2례표현위신염종합정。①11례이불전형막성신병위주요병리표현，면역형광이IgG、C3침적위주，역가견IgA、IgM、C1q침적。②신조직HBsAg여HBcAg양성솔분별위100％（13/13）화76.9％（10/13），강양성솔분별위23.1％（3/13）화15.4％（2/13）。③2례신염종합정환인경항응화잡탁보리치료완전완해；11례신병종합정환인，단순항병독치료2례균미완해；단순당피질격소치료2/3례부분완해，당피질격소가배포소치료2/3례부분완해，당피질격소가용맥고분산지치료3례균완전완해。가용면역억제제환인균미발현간공능이상급HBV-DNA활동표현。결론인동sn HBV-GN적병리이불전형막성신병위주요표현；면역형광현시면역복합물적충류소，침적강도저；맥고분산지연합격소치료교단용격소혹격소연합배포소치료가능유효，단순항병독치료가능무효。
Objective This study performed a retrospective analysis of clinical and pathological features of seronegative hepatitis B virus-associated glomerulonephritis( sn HBV-GN)to explore the safety and efficacy of immunosuppressant treatment. Methods The patients who had been diagnosed with HBV-GN and serum markers was negative( HBsAg and HBV-DNA ) in Beijing Children's Hospital from January 2006 to December 2011 were recruited out. Then the clinical and pathological features were analyzed and followed-up. Results Among 13 patients diagnosed as sn HBV-GN,the ratio of male to female was 1. 6:1,with a mean age at onset of 11. 8 years. Nephrotic syndrome was the most common clinical manifestation(11/13),the other two patients (2/13)were with nephritis syndrome. The pathological feature of most patients had atypical membranous nephropathy(11/13, 84. 6%)as shown by light microscopy. Immunofluorescence staining most commonly showed IgG and C3,IgA,IgM and C1q deposition was also seen. The HBsAg and HBcAg positive rates were 100% and 76. 9%,respectively. The strong positive rate was 23. 1% and 15. 4%,respectively. Two patients with nephritis syndrome were complete remission. Among the 11 patients with nephritic syndrome,2 patients treated with antivirus were non-remission;2 of 3 patients with predinsone were partial remission;2 of 3 patients with prednisone combined with CsA were partial remission;3 patients were complete remission,whose therapeutic schedule was prednisone combined mycophenolate mofetil. None of the patients with immunosuppressive agents showed evidence of HBV activity. Conclusion Atypical membranous nephropathy was the most common pathological feature in children with sn HBV-GN. The intensity and type of deposition in immunofluorescence of sn HBV-GN were low. Prednisone combined mycophenolate mofetil was more effective than single prednisone and prednisone combined Cyclosporine A,single antiviral treatment may be ineffective.