中华肾病研究电子杂志
中華腎病研究電子雜誌
중화신병연구전자잡지
2015年
2期
64-68
,共5页
乙型肝炎病毒相关性肾炎%诊断%中西医结合%治疗
乙型肝炎病毒相關性腎炎%診斷%中西醫結閤%治療
을형간염병독상관성신염%진단%중서의결합%치료
Hepatitis B virus-associated glomerular nephritis%Diagnosis%Integrated traditional Chinese and western medicine%Treatment
乙型肝炎病毒相关性肾炎（HBV-GN）的研究已40余年。其发病机制仍不十分明确，可能与病毒介导的免疫反应有关。HBV-GN 诊断标准为：（1）血清 HBV 抗原阳性；（2）确诊为肾小球肾炎；（3）肾组织中找到 HBV 抗原，其中（2），（3）为必要条件。在诊断 HBV-GN 时应注意排除肾组织HBV 标志物假阳性；排除 HBV 肾组织沉积伴发原发性肾炎；注意与狼疮肾炎的鉴别。HBV-GN 的肾脏病理以膜性肾病及膜增生性肾炎常见。HBV-GN 以肾病综合征及轻微的血尿为主要临床表现。儿童 HBV-GN 患者的病程多呈自限性，而成人 HBV-GN 则常呈缓慢进展，常发展为慢性肾功能衰竭。关于 HBV-GN 治疗的临床报道很多，多为无对照或小样本的回顾性研究，尚无统一的治疗原则可循。抗病毒治疗对 HBV-GN 有一定疗效，而激素和免疫抑制剂的使用尚存争议。抗病毒药[干扰素或核苷类]＋免疫抑制剂[激素和（或）其他免疫抑制剂]＋中药（辨证施治）的治疗模式，可能是较好的选择。
乙型肝炎病毒相關性腎炎（HBV-GN）的研究已40餘年。其髮病機製仍不十分明確，可能與病毒介導的免疫反應有關。HBV-GN 診斷標準為：（1）血清 HBV 抗原暘性；（2）確診為腎小毬腎炎；（3）腎組織中找到 HBV 抗原，其中（2），（3）為必要條件。在診斷 HBV-GN 時應註意排除腎組織HBV 標誌物假暘性；排除 HBV 腎組織沉積伴髮原髮性腎炎；註意與狼瘡腎炎的鑒彆。HBV-GN 的腎髒病理以膜性腎病及膜增生性腎炎常見。HBV-GN 以腎病綜閤徵及輕微的血尿為主要臨床錶現。兒童 HBV-GN 患者的病程多呈自限性，而成人 HBV-GN 則常呈緩慢進展，常髮展為慢性腎功能衰竭。關于 HBV-GN 治療的臨床報道很多，多為無對照或小樣本的迴顧性研究，尚無統一的治療原則可循。抗病毒治療對 HBV-GN 有一定療效，而激素和免疫抑製劑的使用尚存爭議。抗病毒藥[榦擾素或覈苷類]＋免疫抑製劑[激素和（或）其他免疫抑製劑]＋中藥（辨證施治）的治療模式，可能是較好的選擇。
을형간염병독상관성신염（HBV-GN）적연구이40여년。기발병궤제잉불십분명학，가능여병독개도적면역반응유관。HBV-GN 진단표준위：（1）혈청 HBV 항원양성；（2）학진위신소구신염；（3）신조직중조도 HBV 항원，기중（2），（3）위필요조건。재진단 HBV-GN 시응주의배제신조직HBV 표지물가양성；배제 HBV 신조직침적반발원발성신염；주의여랑창신염적감별。HBV-GN 적신장병리이막성신병급막증생성신염상견。HBV-GN 이신병종합정급경미적혈뇨위주요림상표현。인동 HBV-GN 환자적병정다정자한성，이성인 HBV-GN 칙상정완만진전，상발전위만성신공능쇠갈。관우 HBV-GN 치료적림상보도흔다，다위무대조혹소양본적회고성연구，상무통일적치료원칙가순。항병독치료대 HBV-GN 유일정료효，이격소화면역억제제적사용상존쟁의。항병독약[간우소혹핵감류]＋면역억제제[격소화（혹）기타면역억제제]＋중약（변증시치）적치료모식，가능시교호적선택。
Hepatitis B virus-associated glomerular nephritis (HBV-GN)has been studied for over 40 years,but its detailed pathogenesis has not been identified yet,and may be related to HBV-mediated immune reaction.The diagnostic criteria of HBV-GN are comprised of three items;(1)serum HBV antigens are positive,(2)glomerular nephritis is confirmed;(3)HBV antigens are detected in renal tissues;items (2)and (3)are necessary conditions.When HBV-GN is being diagnosed,the following items must be considered:ruling out false positive HBV markers;ruling out primary glomerulonephritis accompanied with HBV deposition in renal tissues;and distinguishing HBV-GN from lupus nephritis.HBV-GN renal pathology is commonly comprised of membranous nephropathy and membranoproliferative nephritis. Nephrotic syndrome and mild hematuria are the main clinical manifestations of HBV-GN.Child HBV-GN is usually self-limited,while adult HBV-GN often slowly progresses into chronic renal failure.There have been a lot of reports about HBV-GN treatment,most of which were retrospective studies without control,and there has not been a unified treatment principle to follow.Antiviral treatment has certain effect for HBV-GN,while there remains controversy about using corticosteroids hormone and immunosuppressive agents.Probably the most viable treatment regimen consists of antiviral drugs (interferon and /or nucleosides),immunosuppressive agents (corticosteroids hormone and /or other immunosuppressive agents),and traditional Chinese medicine (syndrome differentiation treatment).
