Expression And Significance Of Connective Tissue Growth Factor And Nephrin In Hepatitis B Virus-associated Glomerulonephritis

【Objective】1,To observe the expression of connective tissue growth factor(CTGF),transforming growth factor-β1(TGF-β1) and nephrin in hepatitis B virus-associated glomerulo- nephritis (HBV- GN),and explore their roles in the progress of HBV-GN.2,To observe the expression of nephrin in hepatitis B virus-associated membranous nephropathy (HBV-MN), and investigate the impairment and significance of podocyte in HBV-MN.3,To study the clinical and pathological indicators that may effect the prognosis of patients with HBV-GN.【Methods】1,The clinical and pathological data of 87 patients was retrospectively analyzed, who were diagnosed as HBV-GN by renal biopsy.The protein expression of CTGF,TGF-β1 and nephrin in renal biopsy specimens were determined by immunohistochemistry, tested by semi-quantitative method.2,35 patients were selected who were diagnosed as HBV-MN by renal biopsy in the corresponding period,then to analyze their clinical and pathological data and determine the expression of nephrin in renal biopsy specimens by immunohistochemistry,using semi-quantitative method.3,66 patients were followed up who were diagnosed as HBV-GN by renal biopsy in the cor -responding period,then to study the clinical and pathological indicators that may effect the prognosis of the HBV-GN by single factor analysis and multivariate analysis.【Results】1,The expression of CTGF and TGF-β1 in HBV-GN patients'renal biopsy specimens was significantly higher than normal kidneys,and significantly different among different pathological types of HBV-GN. Their expression intensity was positive correlated to the lesion degree of renal tubulointerstitium and glomerulus.The expression of nephrin was significantly lower than that in normal kidneys, and the expression in patients with nephrotic syndrome was significantly lower than that in those with non-nephrotic syndrome. The proportion of its expression strength <6 in membranous nephropathy (MN) and membranoproliferactive glomerulonephritis (MPGN) which were characterized by the injury of podocyte was higher than in mesangial proliferactive glomerulonephritis (MsPGN) and IgA nephropathy (IgAN) which were not characterized by the injury of podocyte.The expression intensity of nephrin was negtive correlated to the lesion degree of renal glomerulus.2,There was no significantly difference in the expression of nephrin among the different stage of HBV-MN.While the expression of nephrin in different clinical types was significantly different,where the expression of nephrin in patients with nephrotic syndrome was lower. Patients were divided into three grades (<1.0g/d;1.0~3.5g/d; >3.5g/d) according to 24-hour urinary protein excretion quantity, and the expression of nephrin in the former two grades were significantly higher than the last grade.And there was some degree negtive correlation between the expression of nephrin and 24-hour urinary protein excretion quantity.3,The stage of chronic kidney disease(CKD),lesion degree of renal tubulointerstitium, TGF-β1 and nephrin were prognosis factors of the HBV-GN patients by single factor analysis,while the multivariate analysis showed that only the lesion degree of renal tubulointerstitium and nephrin were major factors,where the lesion degree of renal tubulointerstitium was an important risk factor and nephrin was an important protective factor.【Conclusion】1,The expression intensity of CTGF and TGF-β1 in HBV-GN patients'renal biopsy specimens could be indexes to the lesion degree of renal tubulointerstitium and glomerulus.And the injury of podocyte is an important progressive mechanism in HBV-GN renal damage, while the down-regulated expression of nephrin is an important occurrence mechanism of the proteinuria.2,The expression of nephrin in HBV-MN patients'renal biopsy specimens,especially in patients with nephrotic syndrome of HBV-MN, is significantly down regulated.There is some degree negtive correlation between the expression of nephrin and 24-hour urinary protein excretion quantity.The expression of nephrin in HBV-MN patients'renal biopsy specimens is closely related to the production of proteinuria.3,The independent prognosistic factors of the HBV-GN is the lesion degree of renal tubulointerstitium and nephrin.The expression of TGF-β1 and nephrin in HBV-GN patients'renal biopsy specimens could be immunopathological indexes to predict the incidence of endpoint events.