乙肝相关性肾小球肾炎及治疗优化

StephenW

Hepatitis B-related glomerulonephritis and optimization of treatment
Yanjun LiuORCID Icon, Cuicui Shi, Jiangao Fan, Baocan Wang & Guangming Li
Pages 113-125 | Received 16 Sep 2019, Accepted 15 Jan 2020, Accepted author version posted online: 17 Jan 2020, Published online: 23 Jan 2020

    Download citation https://doi.org/10.1080/17474124.2020.1717948 CrossMark Logo CrossMark

ABSTRACT

Introduction: Multiple studies have revealed a strong relationship between the development of nephropathy and hepatitis B virus (HBV) infection. The underlying pathogenesis of hepatitis B-related glomerulonephritis (HBV-GN) involves immune complexes, which can be isolated from kidney tissues. Clearance of HBV antigenemia improves renal impairment and proteinuria in HBV-GN patients.

Areas covered: In this review, we present our current understanding of the epidemiology, pathogenesis, pathology, diagnosis, and treatment of HBV-GN. We discuss the advantages and disadvantages of oral nucleoside/nucleotide analogs (NAs), and the main pharmaceutical treatment for hepatis B.

Expert opinion: Currently, antiviral agents are the main HBV-GN therapeutic agents. Although no randomized controlled clinical trials have compared the efficacy of interferon (IFN) and NA, we suggest IFN treatment for pediatric patients (IFN-α in patients ≥1 year; pegIFN-α in patients ≥3 years) considering treatment duration and absence of resistance. Novel NAs have brought about promising treatment options involving high efficacy viral suppression and low resistance rates. NAs with a high barrier to resistance (e.g. entecavir) are recommended as first-line therapy of HBV-GN. Immunosuppression monotherapy, such as corticosteroids, is of little benefit and potentially harmful to HBV-GN patients due to the possibility of viral reactivation.
KEYWORDS: Antiviral therapy, glomerulonephritis, hepatitis B, immune complex, immunosuppressive therapy
Additional information
Funding
This paper was not funded.
Article highlights

    The most common types of hepatitis B related glomerulonephritis include membranous nephropathy, membranoproliferative glomerulonephritis, and mesangial proliferative glomerulonephritis.

    Hepatitis B-related glomerulonephritis predominates in male sex and children.

    Regarding the treatment of HBV-GN, antiviral therapy is preferred rather than immunosuppressive therapy. IFN is a reasonable treatment in pediatric patients in consideration of the definite treatment duration and absence of resistance. NAs with a high barrier to resistance, including entecavir and tenofovir alafenamide, are considered the first-line therapy due to high efficacy in viral suppression and low incidence of resistance.

    Various studies have proven the efficacy of IFN-α, lamivudine, and entecavir in the treatment of HBV-GN with a considerable rate of disease improvement with proteinuria remission.

    The majority of the previous studies present a correlation between hepatitis B e-antigen seroconversion and disease improvement, but this relationship is still under debate.

StephenW

乙肝相关性肾小球肾炎及治疗优化
刘彦军ORCID图标，史翠翠，范建高，王宝灿和李光明
第113-125页于2019年9月16日接收，于2020年1月15日接受，在线接受作者版本：2020年1月17日，在线发表：2020年1月23日

下载引文https://doi.org/10.1080/17474124.2020.1717948 CrossMark徽标CrossMark

抽象

简介：多项研究表明，肾病的发展与乙型肝炎病毒（HBV）感染之间有着密切的关系。乙型肝炎相关性肾小球肾炎（HBV-GN）的潜在发病机制涉及免疫复合物，可以从肾脏组织中分离出来。清除HBV抗原血症可改善HBV-GN患者的肾功能损害和蛋白尿。

涵盖的领域：在本文中，我们介绍了我们对HBV-GN的流行病学，发病机制，病理学，诊断和治疗的当前了解。我们讨论了口服核苷/核苷酸类似物（NAs）的优缺点，以及肝炎B的主要药物治疗方法。

专家意见：目前，抗病毒药是主要的HBV-GN治疗药。尽管目前尚无随机对照临床试验比较干扰素（IFN）和NA的疗效，但考虑到治疗持续时间和是否缺乏干扰素，我们建议对小儿患者进行IFN治疗（≥1年的患者为IFN-α；≥3年的患者为pegIFN-α）。抵抗性。新型NAs带来了有希望的治疗选择，包括高效病毒抑制和低耐药率。建议将耐药性高的NAs（例如恩替卡韦）作为HBV-GN的一线治疗药物。免疫抑制单一疗法（如皮质类固醇）获益不大，由于可能会引起病毒再激活，因此对HBV-GN患者有害。
关键词：抗病毒治疗，肾小球肾炎，乙型肝炎，免疫复合物，免疫抑制治疗
附加信息
资金
该论文未获得资助。
文章重点

乙型肝炎相关性肾小球肾炎最常见的类型包括膜性肾病，膜增生性肾小球肾炎和系膜增生性肾小球肾炎。

在男性和儿童中，乙型肝炎相关的肾小球肾炎占主导地位。

关于HBV-GN的治疗，抗病毒治疗优于免疫抑制治疗。考虑到明确的治疗持续时间和无耐药性，IFN对于小儿患者是一种合理的治疗方法。具有高抗药性的NAs，包括恩替卡韦和替诺福韦阿拉芬酰胺，被认为是一线治疗，因为它在病毒抑制方面具有很高的疗效，且抗药性较低。

各种研究已证明，IFN-α，拉米夫定和恩替卡韦在治疗HBV-GN方面具有显着的蛋白尿缓解率，其疗效显着。

先前的大多数研究表明，乙型肝炎电子抗原血清转化与疾病改善之间存在相关性，但是这种关系仍在争论中。