Clinical Research Of Twenty-eight Adult HBV-associated Glomerulonephritis Patients

BackgroundHBV-associated glomerulonephritis is the renal desease after the hair of hepatitis B virus infection. The essence is the complex- immunopathy resulted in the chronic active hepatitis or the chronic persisting hepatitis. Clinical manifestation presents variable, such as nephrotic syndrom,nephritis syndrom,asymptomatic proteinuria with or without hematuria. The function of Liver or renal mostly have no particularity.Currently,the International diagnose standard have not made decision in consistence. Usually, the golden standard of HBV-GN clinical diagnose is through renal biopsy. But as a wounded surgical operation, renal biopsy can hardly be accepted by people. All these bring difficulties to clinical diagnose.As an antigen-antibody immunocomplex disease, HBV-GN can often be connected with the damage caused by immunoresponsiveness and the activity of inflammatory factor. Glomerular and tubal damage cause obstacle of filtering and repeated absorption, much more protein lost through urine. The immune function mess causes the renal endocrine function Obstacled and the blood vessel factor activated. The most important performance is the renal hemodynamic changes. We should pay more attention to the study of laboratory checkouts and renal hemodynamic changes. Nucleoside similarity have obtained certain effect in appling the treatment of Viral Hepatitis B. Alprostadil, prostaglandin E1, can obviously expand blood vessel and repress the blood platelets gathering. The immunodepression can protect the liver and kidney. Alprostadil can be used as the assistance medicine in HBV-GN treatment.PurposeInvestgate HBV-GN patient's laboratory checkouts,renal hemodynamic changes and the value of pathology diagnosis, and reclamate new basis for the clinical diagnose and treatment of HBV-GN.MethodThe sample who is hospitalizated in our hospital and diagnosed as a HBV-associated glomerulonephritis patients was selected.The observe groups are 10 HBV-GN patients with Chronic Viral Hepatitis B and 15 HBV-GN patients with hepatitis cirrhosis at the stage of activity. In the same age, 10 chronic hepatitis B patients was chosen as control group1. 10 hepatitis cirrhosis patients at the stage of activity was chosen as control group2. we should respectively compare laboratory checkouts and renal hemodynamic changes, analyzing the relationship of clinical diagnose and renal biopsy diagnose.We shall make clinical treatment contrasted analysis in 16 HBV-GN patients.8 patients in comfortable team take Lamivudine0.1g, once a day and use liver protected medicine. At this foundation the treatment group was given Alprostadil 50μg+5% Glucose 250ml injection. Finally we should observe the clinical treatment results.Result 1. The male acts the main role in adult HBV-GN patients. Most patients manifest nephrotic syndrom. The second is nephritis syndrom. The most pathologic performance is membranoproliferative glomerulonephritis. The function of Liver or renal mostly have no particularity. Besides hematuria there are the increase of the level of 24-hours proteinuria and the decrease of the level of serum-albumin. Compared with the chronic hepatitis B, there are significantly statistical difference(P<0.05). When developed to hepatitis cirrhosis at the stage of activity, the difference in serum albumin became not significant(P>0.05). 2. HBV-GN renal hemodynamic changes perform the narrow of renal artery and reduce of the renal blood quantity, and the increase of resistance index using Color Doppler ultra sonography. There is statistical difference compared with the chronic hepatitis B (P<0.05). the difference of the two hepatitis cirrhosis groups at the stage of activity became not significant (P>0.05). 3. Take the renal biopsy as the golden Standard, the sensitivity of clinical diagnosis is 89.47 persent, 99.34 persent of the specitivity, 10.53 persent of the underdiagnosis, 0.66 persent of the misdiagnosis. the sensitivity of clinical diagnosis is lower and the underdiagnosis is higher, clinical diagnosis brings difficulty to treatment. 4.Lamivudine united with Alprostadil was used to treated HBV-GN patients. In aspects of the clinical performance,the recovery of the fanction of liver and kidney and the disappear of proteinuria or hematuria, the treatment group is better than the comfortable group. The liquid disappear speed of the treatment group is quicker than the comfortable group.Conclusion1. Through the clinical performance,the history of HBV infection and laboratory checkouts such as the abnormality of the fanction of liver and kidney,proteinuria and (or) hematuria,the low level of protein in serum, provide the basis for clinical diagnosis. 2. The renal hemodynamic changes using Color Doppler ultra sonography take help for clinical diagnosis. 3. As the first choice of HBV-GN clinical diagnose, the renal biopsy make a main role in patients whose clinical performance is not particular or serum HBV antigen or antibody is negative, and that can not make differentiation from other initial or inherited glomerulonephritis. So it can reduce the underdiagnosis. 4. Lamivudine united with prostaglandin E1 used to treated HBV-GN patients have just accepted good curative effect.We should made furter study.