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中华肾病研究电子杂志 ›› 2015, Vol. 04 ›› Issue (02) : 64 -68. doi: 10.3877/cma.j.issn.2095-3216.2015.02.002

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乙型肝炎病毒相关性肾炎的中西医结合治疗
袁发焕1()   
  1. 1. 400037 重庆市,全军肾脏病中心、重庆市肾脏病研究所、国家中医药管理局重点专科、第三军医大学新桥医院肾内科
  • 出版日期:2015-04-28
  • 通信作者: 袁发焕

Treatment of hepatitis B virus-associated glomerulonephritis with integrated traditional Chinese and western medicine

Fahuan Yuan1,()   

  1. 1. Department of Nephrology, Xinqiao Hospital Affiliated to Third Military Medical University, Renal Disease Center of PLA, Renal Disease Research Institute of Chongqing City, Chongqing 400037, China
  • Published:2015-04-28
  • Corresponding author: Fahuan Yuan
  • About author:
    Corresponding author: Yuan Fahuan, Email:
引用本文:

袁发焕. 乙型肝炎病毒相关性肾炎的中西医结合治疗[J/OL]. 中华肾病研究电子杂志, 2015, 04(02): 64-68.

Fahuan Yuan. Treatment of hepatitis B virus-associated glomerulonephritis with integrated traditional Chinese and western medicine[J/OL]. Chinese Journal of Kidney Disease Investigation(Electronic Edition), 2015, 04(02): 64-68.

乙型肝炎病毒相关性肾炎(HBV-GN)的研究已40余年。其发病机制仍不十分明确,可能与病毒介导的免疫反应有关。HBV-GN诊断标准为:(1)血清HBV抗原阳性;(2)确诊为肾小球肾炎;(3)肾组织中找到HBV抗原,其中(2),(3)为必要条件。在诊断HBV-GN时应注意排除肾组织HBV标志物假阳性;排除HBV肾组织沉积伴发原发性肾炎;注意与狼疮肾炎的鉴别。HBV-GN的肾脏病理以膜性肾病及膜增生性肾炎常见。HBV-GN以肾病综合征及轻微的血尿为主要临床表现。儿童HBV-GN患者的病程多呈自限性,而成人HBV-GN则常呈缓慢进展,常发展为慢性肾功能衰竭。关于HBV-GN治疗的临床报道很多,多为无对照或小样本的回顾性研究,尚无统一的治疗原则可循。抗病毒治疗对HBV-GN有一定疗效,而激素和免疫抑制剂的使用尚存争议。抗病毒药[干扰素或核苷类]+免疫抑制剂[激素和(或)其他免疫抑制剂]+中药(辨证施治)的治疗模式,可能是较好的选择。

Hepatitis B virus-associated glomerular nephritis (HBV-GN) has been studied for over 40 years, but its detailed pathogenesis has not been identified yet, and may be related to HBV-mediated immune reaction. The diagnostic criteria of HBV-GN are comprised of three items; (1) serum HBV antigens are positive, (2)glomerular nephritis is confirmed; (3) HBV antigens are detected in renal tissues; items (2) and (3) are necessary conditions. When HBV-GN is being diagnosed, the following items must be considered: ruling out false positive HBV markers; ruling out primary glomerulonephritis accompanied with HBV deposition in renal tissues; and distinguishing HBV-GN from lupus nephritis. HBV-GN renal pathology is commonly comprised of membranous nephropathy and membranoproliferative nephritis. Nephrotic syndrome and mild hematuria are the main clinical manifestations of HBV-GN. Child HBV-GN is usually self-limited, while adult HBV-GN often slowly progresses into chronic renal failure. There have been a lot of reports about HBV-GN treatment, most of which were retrospective studies without control, and there has not been a unified treatment principle to follow. Antiviral treatment has certain effect for HBV-GN, while there remains controversy about using corticosteroids hormone and immunosuppressive agents. Probably the most viable treatment regimen consists of antiviral drugs (interferon and/or nucleosides), immunosuppressive agents (corticosteroids hormone and/or other immunosuppressive agents), and traditional Chinese medicine (syndrome differentiation treatment).

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