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目的探讨乙型肝炎病毒(HBV)mRNA原位杂交检查在乙型肝炎病毒相关性肾炎(HBV-GN)诊断中的应用价值以及HBV感染在HBV-GN发生中的作用。方法利用原位杂交方法对40例HBV-GN肾组织的石蜡标本进行HBV mRNA检测,并用统计学方法分析HBV mRNA的表达与HBV-GN患者性别、年龄、血肌酐、24小时尿蛋白定量、血清中HBV-DNA载量等临床特征的关系。结果HBV mRNA主要位于肾小管上皮细胞胞质内,部分肾小球上皮、内皮、系膜细胞胞质内也有分布,其阳性率分别为95%(38/40)和20%(8/40),肾小管表达阳性率显著高于肾小球(P<0.01)。HBV mRNA表达在HBV-GN患者性别、年龄、血肌酐等临床特征中无明显差异(P>0.05);在患者24小时尿蛋白定量中差异极显著(P<0.01);与患者血清中HBV-DNA载量间差异显著(P<0.05)。结论HBV-GN肾组织(尤其是肾小管上皮细胞)中存在HBV mRNA,提示HBV可能通过在肾小管上皮细胞内转录、复制,导致肾损害,引发或加重蛋白尿。利用HBV mRNA原位杂交检测可以准确地诊断HBV-GN。
Objective To investigate the value of hepatitis B virus (HBV) mRNA in situ hybridization in the diagnosis of hepatitis B virus-related nephritis (HBV-GN) and the role of HBV infection in the pathogenesis of HBV-GN. Methods HBV mRNA was detected by in situ hybridization in paraffin specimens of 40 cases of HBV-GN nephridial tissues. The expression of HBV mRNA was analyzed by statistical methods in relation to the gender, age, serum creatinine, 24-hour urinary protein, HBV-DNA load and other clinical characteristics of the relationship. Results HBV mRNA was mainly located in the cytoplasm of renal tubular epithelial cells, and some of the glomerular epithelial cells, endothelial cells and mesangial cells were also distributed in cytoplasm. The positive rates of HBV mRNA were 95% (38/40) and 20% (8/40) , And the positive rate of tubular expression was significantly higher than that of glomeruli (P <0.01). HBV mRNA expression in HBV-GN patients with gender, age, serum creatinine and other clinical features no significant difference (P> 0.05); 24h urine protein in patients with significant difference (P <0.01); and serum HBV- DNA load difference was significant (P <0.05). Conclusions HBV mRNA is present in HBV-GN kidney tissues (especially in renal tubular epithelial cells), suggesting that HBV may initiate or aggravate proteinuria by transcription and replication in renal tubular epithelial cells, leading to renal damage. Using HBV mRNA in situ hybridization detection can accurately diagnose HBV-GN.