Ueda T, Gotoh Y, Shiroshita K, Sakurai T, Kataoka Y
Department of Nephrology, Sapporo City General Hospital, Japan.
Nihon Jinzo Gakkai Shi. 1990 Nov;32(11):1153-9.
Hepatitis B virus carriers, a 30-year-old man (case 1) and a 31-year-old man (case 2), associated with nephrotic syndrome were treated with interferon-beta. The nephrotic syndrome did not respond to corticosteroid therapy. Their HBs-Ag, HBe-Ag and HBc-Ab were positive. Renal biopsies revealed membranous glomerulonephritis in case 1 and mixed membranous and proliferative glomerulonephritis in case 2. Direct immunofluorescence studies showed strong granular staining of the GBM with IgG and using sandwich technique with anti-HBe antiserum, granular deposits were seen throughout the GBM. Patients were administrated mainly 3-6 x 10(6) IU/day interferon-beta intravenously for four weeks. After transitory elevation of serum transaminase, HBe-Ag and DNA-polymerase have disappeared with development of HBe-Ab (seroconversion) about six months after the end of interferon-beta administration. Then nephrotic syndrome has recovered in incomplete remission after a year and a half follow-up. The secondary renal biopsy in case 1 showed less intense deposits of HBe-Ag along GBM. These facts suggest that the improvement of proteinuria is associated with the decrease in HBV replication due to interferon therapy.
两名乙肝病毒携带者，一名30岁男性（病例1）和一名31岁男性（病例2），合并肾病综合征，接受了β干扰素治疗。肾病综合征对皮质类固醇治疗无反应。他们的乙肝表面抗原（HBs-Ag）、乙肝e抗原（HBe-Ag）和乙肝核心抗体（HBc-Ab）均为阳性。肾活检显示病例1为膜性肾小球肾炎，病例2为膜性和增殖性肾小球肾炎混合型。直接免疫荧光研究显示，肾小球基底膜（GBM）有强烈的IgG颗粒染色，使用抗乙肝e抗体血清的夹心技术，在整个GBM中可见颗粒状沉积物。患者主要接受3 - 6×10⁶国际单位/天的β干扰素静脉注射，持续四周。血清转氨酶短暂升高后，在β干扰素给药结束约六个月后，乙肝e抗原和DNA聚合酶消失，出现乙肝e抗体（血清转换）。然后，经过一年半的随访，肾病综合征在不完全缓解中恢复。病例1的二次肾活检显示，沿GBM的乙肝e抗原沉积物强度降低。这些事实表明，蛋白尿的改善与干扰素治疗导致的乙肝病毒复制减少有关。
