Clinical Study Of Hepatitis B Virus Associated Nephropathy Treated By Anti-viral Therapy, Anti-viral Combined With Immunosuppressive Therapy

China has a high incidence of viral hepatitis, especially HBV. The number ofchronic asymptomatic HBV carrier in China is probably over1.2billion. Hepatitis Bassociated glomerulonephritis refers to a kind of immune complex glomerulonephritisinduced directly or indirectly by HBV. However, its pathogenesis is so complicatedthat it is still uncertain. The treatment options are still in dispute---it is still unknownthat what kind of patient should be treated by combined therapy and whethercombined therapy is superior to the single use of antiviral therapy. Andimmunosuppressive therapy is expensive and lack of comments from relevant medicaleconomics. Therefore, it is extremely necessary to start research about HBV-GNtreatment.Objective：To assess the efficacy and security of anti-viral therapy and antivirus combinedwith immunosuppressive therapy for Hepatitis B virus-associatedglomerulonephritis.Methods:This study collected23in-patients with HBV-GN that were diagnosed withbiopsyproven HBV-associated GN,these who treated with anti-viral therapy orAntivirus combined with Immunosuppressive therapy and followed-up in ourhospital from2007—2012. Depending on the regimen is divided into antiviruscombined with immunosuppressive therapy group（they were treated with Lamivudinecombined with immunosuppressive therapy8cases）and the anti-viral therapy group（treated with Lamivudine15cases）. Analyze retrospectively clinicalmanifestations, remission rate and the incidence rate of side reaction.Results:There was no significant difference between the two groups in plasma-albumin (Alb),urinary protein of24hours and serum creatinine (P>0.05)，（protein of24hours of antivirus combined with immunosuppressive therapy group（2.27±1.75），plasma-albumin of antivirus combined with immunosuppressive therapygroup(35.13±5.99)；protein of24hours of anti-viral therapy group（2.43±1.63），plasma-albumin of anti-viral therapy group (35.60±7.70)。 But the results aftertreatment compared with before treatment were significantly improved and werehighly significant not only in the antivirus combined with immunosuppressive therapygroup，also the anti-viral therapy group. Three cases got completed remission, partialremission in2cases,3cases appeared no effective in the immunosuppressive therapygroup. And the rate of total effective rate was56.5%.In the anti-viral therapy group,two cases got complete remission,5cases got partial remission and the other7caseshave no significant change in the clinical manifestation and key indicators. And therate of total effective rate was53.3%. Adverse reactions: HBV-DNA increased in1case，1case ALT increased and1case increased in fasting glucose ofimmunosuppressive therapy group,and HBV-DNA in1cases of the15patients of theanti-viral therapy group increased at5months of treatment， but HBV-DNAquantitative stability after the addition of adefovir dipivoxil (ADV), HBV-DNAquantitative of the others in the control group significantly reduced compared withbefore treatmentConclusion：（1）Compared to antiviral drug combined with Immunosuppressive therapy，anti-viral therapy (lamivudine) is safe and effective；（2）Combined with glucocorticoids and immunosuppressive therapy appearsslightly better in effects short-term, but the adverse reactions occurred more;（3）Lamivudine has a certain incidence of resistance，timely addition of thedrug adefovir dipivoxil may continue treatment;（4）The liver and kidney function must be closely monitored during thetreatment of hepatitis B virus replication to ensure the safety of patient care.