Effect Of Deposition Of Renal Tubular Hepatitis B Virus Antigen On Clinic And Pathology Of Hepatitis B Virus-associated Glomerulonephritis

Objective:To investigate the effect of renal tubular hepatitis B virus antigen deposition on the clinical manifestation,pathology and renal function of patients with hepatitis B virus-associated glomerulonephritis(HBV-GN),and to explore the possible mechanism of renal damage to improve the prognosis of HBV-GN judgment.Methods:A retrospective analysis of the clinical manifestations,laboratory indexes and pathological data of 69 cases of hepatitis B virus associated nephritis were confirmed by renal biopsy from January 2009 to January 2016 in Fujian Provincial Hospital.According to the deposition of hepatitis B virus in different parts of renal tissue,the patients were divided into renal tubular group with hepatitis B virus antigen deposition group and renal tubular non-hepatitis B virus antigen deposition group.The clinical manifestations,laboratory indicators,hepatitis B virus serum markers,hepatitis B DNA copy number,renal histopathological type,type of hepatitis B virus antigen deposition,glomerular and renal tubular lesions were analyzed and compared between the two groups.Then the study group was divided into eGFR <60ml / min and eGFR?60ml / min two subgroups,compared with the clinical and pathological characteristics of the study group and analysis of the reasons for the decline in eGFR in the study group.Results:(1)clinical manifestations and laboratory indicators: renal tubular hepatitis B virus antigen deposition group of 23 cases,renal tubular non-hepatitis B virus antigen deposition group of 46 cases.Male and female ratio of 43:26,the average age of 34.6 ± 11.8 years old,both groups were nephrotic syndrome or nephritis syndrome as the main clinical manifestations,some patients with liver dysfunction,renal dysfunction.There were no significant differences in proteinuria,hematuria,blood lipids,hypertension,hemoglobin,uric acid,hepatitis B virus serum markers distribution,hepatitis B virus DNA copy and liver function.However,the incidence of renal dysfunction in renal tubular with hepatitis B virus antigen deposition group was higher than that in renal tubule without hepatitis B antigen deposition group(P <0.05).(2)Hepatitis B virus antigen deposition type in renal tissue:69 cases of 65 cases of HBsAg deposition,11 cases of HBcAg deposition,the two groups are mainly HBsAg deposition.In the study group,23(100%)had HBsAg deposition and 2(8.7%)had HBcAg deposition.In the control group,41(89.1%)had HBsAg deposition and 9(19.6%)had HBcAg,and there was no significant difference between the two groups.(3)Pathological type and degree of tubulointerstitial lesions: membranous nephropathy(36.2%)as the main pathological type,followed by IgA nephropathy(26.1%),membranoproliferative glomerulonephritis(17.4%),mesangial hyperplasia Glomerulonephritis(17.4%),focal segmental glomerulosclerosis(2.9%)?There was no significant difference in the distribution of pathologic types between the two groups.However,the incidence of moderate to severe renal tubulointerstitial lesions in renal tubules with hepatitis B virus antigen deposition(52.2%)was higher than that in renal tubules without hepatitis B virus antigen(17.4%).(P <0.05).(4)In the tubular HBAg positive group,the incidence of severe renal tubular disease in eGFR <60ml / min group was higher than that in eGFR> 60 ml / min group,and there was no significant difference between the two groups in glomerular lesions.Conclusion:Renal tubular HBAg positive group was more likely to develop severe renal tubulointerstitial lesions and renal dysfunction than HBAg negative group,and renal tubular disease was the main cause of renal dysfunction.It is speculated that the mechanism of renal tubular injury in HBV-GN in renal tubules may mediate the progression of HBV-GN and play an important role in the pathogenesis of HBV-GN.Renal tubular hepatitis B virus antigen deposition is an important risk factor for the prognosis of poor prognosis of HBV-GN.