重视隐匿性肝炎与肾小球肾炎的关系

liver411

肾小球肾炎是乙型肝炎（HBV）感染和丙型肝炎（HCV）感染时重要的肝外表现，但HBV感染和HCV感染可以是隐匿的，常被医患双方所忽视。哈尔滨医科大学第三附属医院开展了一项研究，发现隐匿性HBV或HCV感染与肾小球肾炎相关。该研究发表在《国际传染病杂志》上。[Int J Infect Dis. 2013 Mar 6]

       研究人员采用免疫组化方法和电镜扫描等方法，在500例无HBV和HCV感染的血清学证据的肾小球肾炎患者的冰冻肾脏组织中，检测HBsAg，HBcAg和HCV抗原。

       结果发现，500例病例中，9例为HBsAg或HBcAg阳性(9/500, 1.8%)，包括3例HBsAg阳性，6例HBcAg阳性。8例为HCV抗原阳性(8/500, 1.6%)，还有1例为HBV合并HCV感染(1/500, 0.2%)。电子显微镜下，在这些病例样本的肾小球内皮细胞胞质和基底膜中能发现病毒颗粒。最常见的临床表现为肾病综合征(9/18)，其次为肾炎综合征；最常见的病例诊断为膜性肾病（5/18），其次是系膜增生性肾小球肾炎（4/18）和IgA肾病（4/18）。

       作者总结道，隐匿性HBV和HCV感染可能与HBV或HCV相关性肾炎相关，我们应该关注其根本原因。

bigben446

【标题】：Detection of viral antigens in renal tissue of glomerulonephritis patients without serological evidence of hepatitis B virus and hepatitis C virus infection
【作者】：Kong, D.; Wu, D.; Wang, T. (...)
【来源】：Int J Infect Dis, 2013, 17(7), e535-e538
【摘要】：OBJECTIVES: Glomerulonephritis is an important extrahepatic manifestation of hepatitis B virus (HBV) and hepatitis C virus (HCV) infection. HBV and HCV infection may be occult, and they are often overlooked by both patients and doctors. The aim of this study was to assess the importance of HBV and HCV infection in glomerulonephritis patients with undetectable HBV surface antigen (HBsAg) and HCV antibody in serum. METHODS: The HBsAg, the HBV core antigen (HBcAg), and the HCV antigen were detected using immunohistochemistry in frozen renal tissues of 500 glomerulonephritis patients without serological evidence of  HBV and HCV infection. Electron microscopy was used to trace the virus particles, and clinicopathological features were also reviewed. RESULTS: HBsAg or HBcAg was  positive in nine out of 500 cases (9/500, 1.8%). Three cases were HBsAg-positive  and another six cases were HBcAg-positive. The HCV antigen was found in eight cases (8/500, 1.6%). There was one case of HBV and HCV co-infection (1/500, 0.2%). Under electron microscopy, virus particles were found in the base membrane and cytoplasm of endotheliocytes in the glomerulus. The most common clinical manifestation was nephrotic syndrome (9/18), followed by nephritic syndrome (7/18). Membranous nephropathy was the most common pathological diagnosis (5/18), followed by mesangioproliferative glomerulonephritis (4/18) and IgA nephropathy (4/18). CONCLUSIONS: Occult HBV and HCV infection might be implicated in HBV- or  HCV-associated glomerulonephritis. More attention should be focused on the underlying cause.