Hsu H C, Lin G H, Chang M H, Chen C H
Clin Nephrol. 1983 Sep;20(3):121-9.
Fourteen out of 63 children with primary glomerular disease had membranous nephropathy (MN) that was not associated with systemic lupus erythematosus. Hepatitis B surface antigen (HBsAg) was detected in the sera of all 13 patients tested, but was found in only 6.25% of their parents, in 28.57% of their siblings, and in 18.8% of the children with other types of primary glomerular disease. These findings strongly suggest that MN in children in Taiwan is closely related to hepatitis B virus (HBV) infection, and that, in most, if not all, instances it is due to horizontal infection rather than vertical transmission. However, the antigen antibody system involved remains to be identified. In this study, 4 out of 12 cases also showed abnormal elevation of SGOT and SGPT. Liver biopsies obtained from 9 patients demonstrated chronic persistent hepatitis in 3 cases, focal necrosis in 2, and minimal change or normal histology in 4. Although both the liver and kidney diseases appeared to be relatively benign during a limited period of observation, the long-term influence of the diseases and their final outcomes remain to be clarified. With the strong association of HBs antigenemia and MN in children, and the high incidence of HBsAg-positive chronic hepatitis in MN, an investigation of liver function and HBsAg carriage in patients with MN and a study of renal function in HBsAg carriers are highly recommended.
63例原发性肾小球疾病患儿中有14例患有膜性肾病（MN），且与系统性红斑狼疮无关。在所有接受检测的13例患者血清中均检测到乙肝表面抗原（HBsAg），但其父母中仅有6.25%、兄弟姐妹中仅有28.57%以及其他类型原发性肾小球疾病患儿中有18.8%检测到该抗原。这些发现强烈提示，台湾地区儿童的MN与乙肝病毒（HBV）感染密切相关，且在大多数（即便不是全部）情况下是由于水平感染而非垂直传播所致。然而，所涉及的抗原抗体系统仍有待确定。在本研究中，12例病例中有4例还出现谷草转氨酶（SGOT）和谷丙转氨酶（SGPT）异常升高。对9例患者进行肝活检，结果显示3例为慢性持续性肝炎，2例为局灶性坏死，4例组织学改变轻微或正常。尽管在有限的观察期内肝脏和肾脏疾病似乎都相对良性，但这些疾病的长期影响及其最终结局仍有待阐明。鉴于儿童中HBs抗原血症与MN之间存在强关联，且MN中HBsAg阳性慢性肝炎的发病率较高，强烈建议对MN患者进行肝功能和HBsAg携带情况调查，并对HBsAg携带者进行肾功能研究。
