乙型肝炎病毒相关性肾炎不同基因型患儿间临床及病理特征的差异分析

Clinical and pathological differences between children with various genotypes of hepatitis B virus-associated glomerulonephritis

摘要:

目的 研究乙型肝炎病毒相关性肾炎(HBV-GN)不同基因型患儿间临床及病理特征的差异。方法 随机选择同时行肝穿和肾穿的41 例HBV-GN 患儿作为研究对象,对其血清标本进行基因分型、乙型肝炎病毒(HBV)cccDNA 检测,分析HBV-GN 不同基因型患儿间临床、病理特征及HBV 复制的差异。结果 41例HBV-GN 患儿中,C 基因型29 例(71%),B 基因型10 例(24%),B/C 混合型2 例(5%)。C 基因型患儿的血尿、蛋白尿、补体C3 下降、谷丙转氨酶升高及肾功能不全发生率均显著高于B 基因型患儿;C 基因型患儿HBV cccDNA 阳性比例高于B 基因型患儿。但两种不同基因型患儿肾组织病理类型分布差异无统计学意义;两者肝组织炎症程度及纤维化程度差异亦无统计学意义。结论 HBV-GN 的基因型主要以C、B 基因型为主,且以C 基因型占优势。C 基因型患儿较B 基因型临床症状严重,但两者在病理学特征上无明显差异。

Abstract:

Objective To compare the clinical and pathological features between children with various genotypes of hepatitis B virus-associated glomerulonephritis (HBV-GN). Methods Forty-one children with HBVGN concurrently undergoing liver and renal biopsy were randomly selected. Serum specimens were collected for genotyping and hepatitis B virus (HBV) cccDNA assay. The clinical, pathological, and HBV cccDNA differences between HBV-GN children of various genotypes were analyzed. Results Among the 41 HBV-GN children, 29 (71%) were genotype C, 10 (24%) were genotype B, and 2 (5%) were genotype B/C. The incidence rates of hematuria, albuminuria, complement 3 decrease, alanine transaminase increase, and renal insufficiency in the genotype C group were significantly higher than those in the genotype B group (P<0.05). Similarly, the HBV cccDNA positive rate was significantly higher in the genotype C group than that in the genotype B group. No difference was observed in the distribution of pathological types of renal tissues betwee the two geonotype groups. There were no significant differences in the degrees of hepatic inflammation and fibrosis between the two groups. Conclusions Mainly genotypes C and B occur in children with HBV-GN and the former genotype is dominant. The clinical symptoms of patients with genotype C are more serious than those with genotype B. However, there is no difference in the pathological features between them.