MEMBRANOUS NEPHROPATHY RELATED TO HEPATITIS-B VIRUS IN ADULTS
MEMBRANOUS NEPHROPATHY RELATED TO HEPATITIS-B VIRUS IN ADULTS
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DOI：
10.1056/nejm199105233242103
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发表时间：
1991-05-23
影响因子：
158.5
通讯作者：
LAI, FM
中科院分区：
文献类型：
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作者：
LAI, KN;LI, PKT;LAI, FM
背景。成人乙型肝炎病毒（HBV）相关膜性肾病在HBV感染流行地区（以儿童早期HBV垂直和水平传播为特征）的自然病程尚未完全确定。我们评估了21例成人发病的hbv相关膜性肾病患者的临床特征、病理表现、血清学特征、治疗反应和预后。患者平均随访60个月（12 ~ 108个月）。只有在肾活检标本中有肾小球毛细血管沉积乙型肝炎抗原（HBeAg）证据的患者才被纳入研究。临床特征和血清学研究提示患者在幼儿期获得慢性HBV感染；此外，已经排除了膜性肾病的其他原因。所有患者首次临床表现为乙型肝炎表面抗原血清阳性，乙型肝炎核心抗原抗体滴度高。在17例患者（81%）的血清中检测到HBeAg，但只有3例患者的血浆丙氨酸转氨酶水平略有升高。干扰素治疗的临床反应令人失望；在接受治疗的5名患者中，只有1名患者的血清转化为HBeAg抗体，完全缓解。与儿童研究报告相反，在我们研究的成人hbv相关膜性肾病患者中，肾病综合征或蛋白尿的自发缓解并不常见。未经治疗的患者持续存在蛋白尿和HBV抗原血症。在随访期间，29%的患者出现了进行性肾功能衰竭，10%的患者需要维持透析治疗。乙肝病毒相关膜性肾病在成人乙肝病毒流行地区的病程不是良性的。无论如何治疗，该病在大约三分之一的患者中具有缓慢但无情的临床进展过程。
Background. The natural course of adult hepatitis B virus (HBV)-related membranous nephropathy in areas where HBV infection is endemic (characterized by vertical and horizontal transmission of HBV in early childhood) has not been fully defined.Methods. We evaluated the clinical features, pathological findings, serologic profiles, therapeutic responses, and prognoses of 21 patients with adult-onset HBV-related membranous nephropathy. The patients were followed for a mean of 60 months (range, 12 to 108). Only patients with evidence of glomerular capillary deposition of hepatis B e antigen (HBeAg) in a renal-biopsy specimen were included.Results. The clinical features and serologic studies suggested that the patients had acquired chronic HBV infection in early childhood; moreover, other causes of membranous nephropathy had been excluded. All were seropositive for hepatitis B surface antigen and had high titers of antibody to hepatitis B core antigen at first clinical presentation. HBeAg was detected in the serum of 17 patients (81 percent), yet only 3 had even slightly increased plasma alanine aminotransferase levels. The clinical response to therapy with interferon alfa was disappointing; only one of the five patients treated had a complete remission with seroconversion to antibody to HBeAg. Contrary to reports of studies in children, spontaneous remission of the nephrotic syndrome or proteinuria was uncommon in the adults with HBV-related membranous nephropathy whom we studied. Proteinuria and HBV antigenemia persisted in untreated patients. During the follow-up period, 29 percent of the patients had progressive renal failure and 10 percent required maintenance dialysis therapy.Conclusions. The course of HBV-related membranous nephropathy in adults in areas where HBV is endemic is not benign. Regardless of treatment, the disease has a slowly but relentlessly progressive clinical course in approximately one third of patients.