Nakahara Kazunari, Takahashi Hideaki, Okuse Chiaki, Shigefuku Ryuta, Yamada Norie, Murao Mei, Matsunaga Kotaro, Koike Junki, Yotsuyanagi Hiroshi, Suzuki Michihiro, Kimura Kenjiro, Itoh Fumio
Department of Internal Medicine, Division of Gastroenterology and Hepatology, St. Marianna University, School of Medicine, Kawasaki.
Intern Med. 2010;49(5):383-8. doi: 10.2169/internalmedicine.49.2812. Epub 2010 Mar 1.
We herein present a case of membranous nephropathy associated with chronic hepatitis B following acute hepatitis B virus (HBV) infection. A 22-year-old man was admitted to our hospital for evaluation of proteinuria, pitting edema on both legs, and increased body weight in December 2002. At the age of 18, he had suffered from acute hepatitis A and syphilis, and was found to be negative for hepatitis B surface antigen (HBsAg). Furthermore, he suffered from acute hepatitis B (AH-B) at the age of 21; he was found to be positive for HBsAg and anti-IgM antibody to core antigen (IgM HBcAb). However, he discontinued outpatient treatment before confirmation of HBsAg clearance or the appearance of antibody to HBsAg (HBsAb). At the present admission, HBsAg, antibody to hepatitis B e antigen (HBeAg), and HBcAb were positive, while IgM HBcAb was negative. His genotype of HBV was type A (HBV/A). Histopathological findings of the renal biopsy specimen confirmed glomerulonephritis and glomerular deposition of HBsAg. Thus, he was diagnosed as having nephrotic syndrome caused by membranous nephropathy (MN) associated with chronic hepatitis B (CH-B) following AH-B. Although interferon-alpha (IFN-alpha) administration was started for the treatment and temporary improvement of proteinuria was observed, remission of MN was not achieved.
我们在此报告一例急性乙型肝炎病毒（HBV）感染后并发慢性乙型肝炎的膜性肾病病例。一名22岁男性于2002年12月因蛋白尿、双下肢凹陷性水肿及体重增加入院接受评估。18岁时，他曾患急性甲型肝炎和梅毒，乙肝表面抗原（HBsAg）检测为阴性。此外，他21岁时患急性乙型肝炎（AH - B）；HBsAg及核心抗原IgM抗体（IgM HBcAb）检测呈阳性。然而，在HBsAg清除或出现乙肝表面抗体（HBsAb）之前，他中断了门诊治疗。此次入院时，HBsAg、乙肝e抗原抗体（HBeAg）及HBcAb呈阳性，而IgM HBcAb呈阴性。其HBV基因型为A型（HBV/A）。肾活检标本的组织病理学检查结果证实为肾小球肾炎及HBsAg在肾小球沉积。因此，他被诊断为AH - B后并发慢性乙型肝炎（CH - B）的膜性肾病（MN）所致肾病综合征。尽管开始使用α干扰素（IFN - α）进行治疗并观察到蛋白尿有短暂改善，但MN未实现缓解。
