Iwata Y, Wada T, Yoshimoto K, Sakai N, Shimizu M, Furuichi K, Hisada Y, Kobayashi K, Yokoyama H
First Department of Internal Medicine, Kanazawa University, Kanazawa, Japan.
Nihon Jinzo Gakkai Shi. 2001;43(2):76-81.
We experienced a 24-year-old Japanese man, who was a hepatitis B virus carrier with nephrotic syndrome. Liver biopsy showed that he was suffering from chronic hepatitis (activity 2, fibrosis 2). Renal biopsy revealed membranous nephropathy(MN) with focal segmental glomerulosclerosis(FGS). Immunofluorescentic findings revealed the presence of HBe antigen along the glomerular capillaries as well as HBe antigenemia in circulation. Therefore, we diagnosed this case as HB virus-related membranous nephropathy associated with FGS lesions. He was treated with interferon(IFN) alpha-2b for over a month and angiotensin converting enzyme inhibitor. These therapies reduced urinary protein excretion from 4-6 g/day to 1-2 g/day, in accordance with a decrease in the titer of HBV DNA polymerase. The second renal biopsy revealed that the histological change from MN to membranoproliferative glomerulonephritis Type III after IFN therapy. These results suggest that IFN therapy might be effective for HB virus-related MN associated with FGS.
我们遇到一名24岁的日本男性，他是一名患有肾病综合征的乙肝病毒携带者。肝活检显示他患有慢性肝炎（活动度2级，纤维化2级）。肾活检显示为膜性肾病（MN）合并局灶节段性肾小球硬化（FGS）。免疫荧光检查结果显示沿肾小球毛细血管存在HBe抗原以及循环中的HBe抗原血症。因此，我们将该病例诊断为与FGS病变相关的乙肝病毒相关性膜性肾病。他接受了一个多月的α-2b干扰素（IFN）和血管紧张素转换酶抑制剂治疗。这些治疗使尿蛋白排泄量从每天4 - 6克降至1 - 2克，同时乙肝病毒DNA聚合酶滴度降低。第二次肾活检显示干扰素治疗后组织学变化从MN转变为III型膜增生性肾小球肾炎。这些结果表明，干扰素治疗可能对与FGS相关的乙肝病毒相关性MN有效。
