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目的探讨免疫荧光病理检验在乙型肝炎病毒相关性肾小球肾炎(HBV-GN)诊断中的临床意义。方法回顾性分析70例经肾活检病理明确诊断为HBV-GN患者的临床病理资料。结果 HBV-GN病理以膜性肾病多见,临床表现为肾病综合征者占44.3%,慢性肾衰竭占10.0%。“满堂亮”阳性率(免疫荧光病理检验IgG、IgA、IgM、C1q和C3均阳性)占40.0%(其中膜性肾病占25.7%)。肾组织单项HBsAg沉积为最多见,达65.7%;而单项HBcAg沉积相对少见。结论肾组织HBV抗原沉积现象可以出现在血清HBV标志物阴性或仅HBsAb阳性的患者,提示应重视肾组织HBV抗原免疫荧光病理检测的敏感性及做多种HBV抗原检测,从而降低HBV-GN的漏诊率,对早期诊断HBV-GN具有至关重要的临床意义。
Objective To investigate the clinical significance of immunofluorescence staining in the diagnosis of hepatitis B virus-associated glomerulonephritis (HBV-GN). Methods The clinical and pathological data of 70 patients with HBV-GN diagnosed by renal biopsy were retrospectively analyzed. Results The pathology of HBV-GN was common in membranous nephropathy. The clinical manifestations were nephrotic syndrome (44.3%) and chronic renal failure (10.0%). The positive rate (IgG, IgA, IgM, C1q and C3 in immunofluorescence staining) accounted for 40.0% (25.7% of membranous nephropathy). Kidney tissue single HBsAg deposition is the most common, up to 65.7%; and individual HBcAg deposition is relatively rare. Conclusions The deposition of HBV antigens in renal tissue may occur in patients with negative serum HBV markers or only HBsAb positive, suggesting that the sensitivity of immunofluorescence in renal tissue to HBV antigens and the detection of multiple HBV antigens should be emphasized, and HBV-GN Misdiagnosis rate, early diagnosis of HBV-GN has clinically important significance.