Yu Feng, Li Guanglan, Hao Wenke, Hu Wenxue
Department of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong Provincial Geriatrics Institute, Guangzhou, 510080, People's Republic of China.
Shantou University Medical College, Shantou, 515041, People's Republic of China.
Int J Gen Med. 2021 Jun 30;14:3069-3077. doi: 10.2147/IJGM.S318087. eCollection 2021.
The clinicopathologic characteristics of Hepatitis B virus-associated glomerulonephritis (HBV-GN) patients with different serum HBsAg are not well known. This study aims to investigate the characteristics and treatments between HBV-GN patients with positive and negative serum HBsAg.
A retrospective review of patients with renal biopsies in Guangdong Provincial People's Hospital from 2005 to 2018 was performed. Clinicopathological data, treatments and remission of proteinuria were collected and compared between HBsAg+ and HBsAg- group.
A total of 101 HBV-GN were recruited. Serum HBsAg+ and HBsAg- patients accounted for 62.4% and 37.6%, respectively. HBsAg+ group had poor kidney and liver functions. Pathological data showed the percentage of membranous nephropathy in HBsAg- group is significantly higher than that of HBsAg+ group (60.3% HBsAg+ vs 89.5% HBsAg-, <0.05). Chronic renal tubular/interstitial injury was more prevalent in HBsAg+ group (16.9% HBsAg+ vs 2.6% HBsAg-, <0.05). The deposition sites of immune complexes were significant different between the two groups. In addition, more HBsAg+ patients were given anti-HBV and less were given corticosteroid or immunosuppressants for treatment than that of HBsAg- patients. Percentages of clinical remission were increasing in both HBsAg+ and HBsAg- patients from 1, 3, 6 months to 1 year (18.75%, 45.2%, 67.8%, 82.4% vs 24.4%, 41.2%, 62.8%, 59.3%). The differences of remission betwen two groups were not significant (>0.05).
The clinicopathological characteristics and treatments of HBV-GN with serum HBsAg+ and HBsAg- were distinct, which indicated that the pathogenesis might be different and specific treatments were needed for HBV-GN patients with different serum HBsAg.
不同血清乙肝表面抗原（HBsAg）的乙型肝炎病毒相关性肾小球肾炎（HBV-GN）患者的临床病理特征尚不清楚。本研究旨在探讨血清HBsAg阳性和阴性的HBV-GN患者的特征及治疗方法。
对2005年至2018年在广东省人民医院进行肾活检的患者进行回顾性研究。收集并比较HBsAg阳性组和HBsAg阴性组的临床病理资料、治疗情况及蛋白尿缓解情况。
共纳入101例HBV-GN患者。血清HBsAg阳性和阴性患者分别占62.4%和37.6%。HBsAg阳性组患者的肾功能和肝功能较差。病理数据显示，HBsAg阴性组膜性肾病的比例显著高于HBsAg阳性组（HBsAg阳性组为60.3%，HBsAg阴性组为89.5%，P<0.05）。慢性肾小管/间质损伤在HBsAg阳性组更为常见（HBsAg阳性组为16.9%，HBsAg阴性组为2.6%，P<0.05）。两组免疫复合物的沉积部位存在显著差异。此外，与HBsAg阴性患者相比，更多的HBsAg阳性患者接受了抗HBV治疗，而接受皮质类固醇或免疫抑制剂治疗的患者较少。HBsAg阳性和阴性患者从1个月、3个月、6个月到1年的临床缓解率均呈上升趋势（分别为18.75%、45.2%、67.8%、82.4%和24.4%、41.2%、62.8%、59.3%）。两组缓解率的差异无统计学意义（P>0.05）。
血清HBsAg阳性和阴性的HBV-GN患者的临床病理特征和治疗方法不同，这表明其发病机制可能不同，对于不同血清HBsAg的HBV-GN患者需要采取针对性的治疗措施。
