Liu Ting, Yang Shicong, Yue Zhihui, Kuang Yu, Guan Weiming, Sun Liangzhong
Children's Kidney Disease Center, Department of Pediatrics, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
Department of Pathology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
J Clin Virol. 2015 May;66:1-5. doi: 10.1016/j.jcv.2015.02.012. Epub 2015 Feb 20.
Hepatitis B virus-associated glomerulonephritis (HBV-GN) mainly occurs in children. Patients with HBV-GN are frequently positive for serum HBV surface antigen (HBsAg), but they are rarely negative.
To explore the clinical and pathological characteristics of patients with HBV-GN who are serum HBsAg negative.
Five children with HBV-GN who are negative for HBsAg were included in this study. Their clinical and pathological characteristics were collected and analyzed.
All 5 children presented with different levels of proteinuria and microscopic hematuria. Renal biopsies showed membranous nephropathy accompanied by HBsAg and/or HBcAg deposits in glomeruli in all of the children. Steroids and/or other immunosuppressants were administered in all cases without antiviral therapy during the early stages of treatment. Two children achieved complete remission but relapsed after the drugs were tapered down. The other 3 children were initially non-responsive but achieved remission after lamivudine was added.
Treatment of HBsAg-negative HBV-GN patients with immunosuppressants alone could not achieve satisfactory effects. Antiviral treatment is effective and may be necessary in this type of patient.
乙型肝炎病毒相关性肾小球肾炎（HBV-GN）主要发生于儿童。HBV-GN患者血清乙型肝炎病毒表面抗原（HBsAg）常呈阳性，但极少呈阴性。
探讨血清HBsAg阴性的HBV-GN患者的临床和病理特征。
本研究纳入5例HBsAg阴性的HBV-GN儿童患者。收集并分析其临床和病理特征。
所有5例儿童均出现不同程度的蛋白尿和镜下血尿。肾活检显示所有患儿均为膜性肾病，肾小球内伴有HBsAg和/或HBcAg沉积。所有病例在治疗初期均给予类固醇和/或其他免疫抑制剂，未进行抗病毒治疗。2例患儿完全缓解，但在药物减量后复发。另外3例患儿最初无反应，但在加用拉米夫定后缓解。
单独使用免疫抑制剂治疗HBsAg阴性的HBV-GN患者不能取得满意疗效。抗病毒治疗有效，对这类患者可能是必要的。
