Takekoshi Y
Hokkaido Igaku Zasshi. 1979 Nov;54(6):579-95.
A total of 163 Japanese children (90 boys and 73 girls, ranging in age from 3 to 15) with proteinuria and/or hematuria were studied for renal histopathology using biopsy materials by light microscopy, electron microscopy, and immunofluolescence method. Eleven patients were diagnosed as membranous nephropathy (MN) while the other 152 patients had various renal diseases other than MN. All patients with MN did not have any known predisposing of associated caused. Hepatitis B virus surface antigen (HBsAg) in the serum, as determined by a reversed passive hemagglutination method (RPHA), was positive in 100% of the patients with MN, while it was positive in 4.6% of the patients with other renal diseases. The difference was statistically significant. Of the 11 mothers of the children with MN, six were positive for HBsAg, and one of the remaining 2 was positive for antibody to HGsAg (anti-HBs) and another was not examined. These findings suggest that MN among Japanese children are mainly, if not exclusively, caused by hepatitis B virus (HBV) and that the virus is transmitted from the mother to child in most instances. In each case of HBsAg-associated glomerulonephritis reported, HBsAg was detected, by immunofluorescence, in the glomeruli, with a distribution similar to that of immunoglobulins. However deposits of HBsAg could not be demonstrated in the glomeruli of the 9 patients with MN studied. Pathogenic immune complexes in the glomerular lesions with subepithelial deposits have been shown to weigh less than 1 million daltons. Since the intact 20-nm HBsAg has a molecular weight of more than 2.4 million daltons, probably most immune complexes containing it would be very large and rapidly cleared by the reticuloendothelial system. Therefore, this failure to detect glomerular staining with anti-HBs antiserum may mean that MN is caused by some other antigen, of a lower molecular weight, associated with HBV, but not necessarily by HB surface antigen.
对163名患有蛋白尿和/或血尿的日本儿童（90名男孩和73名女孩，年龄在3至15岁之间）进行了研究，使用活检材料通过光学显微镜、电子显微镜和免疫荧光法对其进行肾脏组织病理学检查。11名患者被诊断为膜性肾病（MN），而其他152名患者患有除MN以外的各种肾脏疾病。所有MN患者均无任何已知的相关诱发因素。通过反向被动血凝法（RPHA）测定，MN患者血清中的乙型肝炎病毒表面抗原（HBsAg）阳性率为100%，而其他肾脏疾病患者的阳性率为4.6%。差异具有统计学意义。在11名MN患儿的母亲中，6名HBsAg阳性，其余2名中1名乙型肝炎表面抗原抗体（抗-HBs）阳性，另1名未检查。这些发现表明，日本儿童的MN主要（如果不是唯一的话）由乙型肝炎病毒（HBV）引起，并且在大多数情况下该病毒是母婴传播的。在每例报道的与HBsAg相关的肾小球肾炎病例中，通过免疫荧光在肾小球中检测到HBsAg，其分布与免疫球蛋白相似。然而，在所研究的9例MN患者的肾小球中未证实有HBsAg沉积。已显示具有上皮下沉积物的肾小球病变中的致病性免疫复合物分子量小于100万道尔顿。由于完整的20纳米HBsAg分子量超过240万道尔顿，可能大多数含有它的免疫复合物会非常大并被网状内皮系统迅速清除。因此，未能用抗-HBs抗血清检测到肾小球染色可能意味着MN是由与HBV相关的其他分子量较低的抗原引起的，但不一定是由HB表面抗原引起的。
