文章摘要
高 鹏,赵桂玲.乙型肝炎病毒在不同ALT状态下对乙型肝炎相关性肾小球肾炎的影响[J].南京医科大学学报,2020,(4):575~578
乙型肝炎病毒在不同ALT状态下对乙型肝炎相关性肾小球肾炎的影响
The effects of hepatitis B virus on hepatitis B virus associated glomerulone nephritis under different ALT stages
投稿时间:2018-12-05  
DOI:10.7655/NYDXBNS20200420
中文关键词: 乙型肝炎相关性肾小球肾炎  乙型肝炎病毒  肾功能  慢性肾脏病分期
英文关键词: hepatitis B virus associated glomerulone nephritis  hepatitis B virus  renal function  chronic kidney disease staging
基金项目:兰州大学第一医院院内基金(ldyyyn2014?14)
作者单位
高 鹏 兰州大学第一医院传染病研究室甘肃 兰州 730000 
赵桂玲 兰州大学第一医院肾病科甘肃 兰州 730000 
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中文摘要:
      目的:探讨不同丙氨酸氨基转移酶(alanine aminetransferase,ALT)状态下不同载量的乙型肝炎病毒(hepatitis B virus,HBV)对乙型肝炎相关性肾小球肾炎(hepatitis B virus?associated glomerulone nephritis,HBV?GN)的影响。方法:回顾性分析兰州大学第一医院确诊为HBV?GN的患者646例,化验指标包括:尿N?乙酰?β?D?葡萄糖苷酶(N?acetyl?β?D?glucosidase,NAG)、尿β2微球蛋白(β2 microglobulin,β2M),肝功能指标ALT,肾功能指标肌酐、血尿素氮、肾小球滤过率(glomerular filtration rate,GFR)。荧光定量PCR法测量HBV载量。对646例HBV?GN病理类型分布进行统计,分析不同ALT状态下HBV载量对HBV?GN肾脏功能及肾脏病分期的影响。结果:HBV?GN以弥漫性膜增生性肾病为主,约占60.7%,其次为毛细血管内增生性肾小球肾炎,约占26.2%,局灶节段肾小球硬化和系膜增生性病变较为少见。在ALT正常组HBV对肾脏功能指标无明显影响。而在ALT异常组中HBV对肾脏功能指标有影响,特别以ALT≥2倍正常值上限(upper limit of normal,ULN)组中为甚。随着病毒载量的增高,血肌酐、血尿素氮、24 h尿蛋白定量、尿NAG、尿β2M明显增高,而GFR明显下降,差异均有统计学意义(P < 0.05)。在ALT正常组和ALT<2ULN组中,HBV对慢性肾脏病分期无明显影响;而在ALT≥2ULN组中,随着病毒载量的增高,慢性肾脏病分期有加重倾向。结论:在不同ALT状态下,HBV对HBV?GN的影响是不同的,综合分析这一现象,有助于临床更好地诊断和治疗该疾病。
英文摘要:
      Objective:To investigate the effect of hepatitis B virus(HBV)on the HBV associated glomerulone nephritis(HBV?GN)under different alanine aminetransferase(ALT)levels. Methods:A total of 646 HBV?GN patients in the First Hospital of Lanzhou University were analyzed retrospectively. All the selected patients have complete medical records and have undergone renal histopathology. Laboratory tests include:N?acetyl?β?D?glucosidase(NAG),β2 microglobulin(β2M),liver function parameters ALT,renal function parameters creatinine(Cr),blood urea nitrogen(BUN),glomerular filtration rate(GFR). The HBV loads were measured by quantitative PCR. The distribution of pathological types of 646 HBV?GN was investigated,and the effects of HBV loads on renal function of the HBV?GN and stage of chronic kidney disease under different ALT levels were analyzed. Results:HBV?GN is mainly diffuse membrane hypertrophic nephropathy,accounting for about 60.7%,followed by capillary hyperplastic glomerulonephritis,accounting for about 26.2%,the focal segment glomerulonephritis and mesenteric hyperplastic lesions are rare. In the ALT normal HBV?GN patients group,the effect of HBV on the renal function is minor,while in the ALT abnormal group,the effect is significant,and this difference is obvious in the ALT≥2ULN(upper limit of normal). With viral load increasing,blood Cr,BUN,24 h urine protein quantification,urine NAG,β2M increased,while GFR decreased(P < 0.05). In the normal ALT group and the ALT<2ULN group,the viral load has no relationship with chronic kidney disease staging,but in the ALT≥2ULN group the viral load had a significant relationship with the chronic kidney disease staging. Conclusion:In different ALT condition,the effect of HBV on HBV?GN is different. A comprehensive analysis of this phenomenon is conducive to the clinical diagnosis and treatment of this disease.
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