切换至 "中华医学电子期刊资源库"

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

所属专题: 文献

专家论坛

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]. 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]. 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).

[1]
Combes B, ShoreyJ, BarreraA,et al. Glomerulonephritis with deposition of Australia antigen-antibody complexes in glomerular basement membrane [J]. Lancet, 1971, 2(7718): 234-237.
[2]
中华内科杂志编委会.乙型肝炎病毒相关性肾炎座谈会纪要[J].中华内科杂志,1990, 29(9): 519.
[3]
吴碧青. 乙型肝炎病毒相关性肾炎发病机制研究进展[J].中国医药,2006,1(7):446-448.
[4]
叶任高,李幼姬,刘冠贤. 临床肾脏病学[M].北京:人民卫生出版社,2008:253-254.
[5]
杨光,王金泉.乙肝病毒相关性肾炎//黎磊石,刘志红.中国肾脏病学[M].北京:人民军医出版社,2008:722-727.
[6]
王勇雄,应伟中,邱长斌,等. 狼疮性肾炎肾内HBsAg沉积临床意义的初探[J].中华肾脏病杂志,1990,6(2):94-97.
[7]
张月娥,郭慕依,应越英,等. 乙型肝炎病毒免疫复合物肾小球肾炎的免疫病理的进一步研究[J]. 中华内科杂志,1990,29(8):526-529.
[8]
刘波,庄永泽,余英豪.呈肾病综合征的乙型肝炎病毒相关性肾炎临床病理特点[J].中国中西医结合肾病杂志,2013,14(5):416-419.
[9]
Han SH. Extrahepatic manifestations of chronic hepatitis B [J]. Clin Liver Dis, 2004, 8(2): 403-418.
[10]
Zhang Y, Zhou JH, Yin XL,et al. Treatment of hepatitis B virus-associated glomerulonephritis: a meta-analysis [J]. World J Gastroenterol, 2010, 16(6): 770-777.
[11]
詹欣宇,肖琳,银皓,等.乙型肝炎病毒相关性肾炎药物治疗的Meta分析[J].中国肝脏病杂志,2014,6(1):38-45.
[12]
郄兰霞,范蓉.中西医结合治疗乙肝病毒相关性肾炎疗效分析[J].河北中医药学报,2014,29(1):9-10.
[13]
Zhang L, Meng H, Han X, et al. The relationship between HBV serum markers and the clinicopathological characteristics of hepatitis B virus-associated glomerulonephritis (HBV-GN) in the northeastern Chinese population [J]. Virol J, 2012, 9: 200.
[14]
Lei X.The genotype C could play a key role in hepatitis B virus associated nephritis among the northwest Chinese children [J]. Eur J Intern Med, 2013, 24(8): 835-838.
[15]
毕爽,马晓燕. 辨证治疗乙型肝炎病毒相关性肾炎[J]. 实用中医内科杂志,2013,27(4):160-161.
[16]
Chan TM. Hepatitis B and renal disease [J]. Curr Hepat Rep, 2010, 9(2): 99-105.
[17]
耿兴花,孙珉丹. 乙型肝炎病毒相关性肾炎的研究进展[J]. 吉林医学,2009,30(15):1702-1704.
[18]
Elwell RJ, Neumann M, Bailie GR. Factors associated with long term antibody production induced by hepatitis B vaccine in patients: a retrospective cohort study [J]. Phormacotherapy, 2003, 23(12): 1558-1563.
[19]
Fabrizi F, Dixit V, Martin P. Meta-analysis: anti-viral therapy of hepatitis B virus-associated glomerulonephritis [J]. Aliment Pharmacol Ther, 2006, 24(5): 781-788.
[20]
Xu G, Huang T. Hepatitis B virus-associated glomerular nephritis in East Asia: Progress and challenges [J]. Eur J Intern Med, 2011, 22(2): 161-166.
[21]
Kanaan N, Horsmans Y, Goffin E. Lamivudine for nephritic syndrome related to hepatitis B virus (HBV) infection [J]. Clin Nephrol, 2006, 65(3): 208-210.
[22]
段忠辉,孟庆华. 拉米夫定和阿德福韦及恩替卡韦治疗乙肝的现状和进展[J].中国全科医学,2007,10(1):67-71.
[23]
Panomsak S, Lewsuwan S, Eiam-Ong S, et al. Hepatitis-B virus-associated nephropathies in adults: a clinical study in Thailand [J]. Med Assoc Thai, 2006, 89(Suppl 2): S151-S156.
[24]
Zhang Y, Zhou JH, Yin XL,et al. Treatment of hepatitis B virus-associated glomerulonephritis: a meta-analysis [J]. World J Gastroenterol, 2010,16(6): 770-777.
[25]
何光向,郑宋明. 乙肝病毒相关性肾炎的诊断与治疗[J]. 浙江中西医结合杂志,2008,18(6):358-359.
[26]
Liu J, Xin KM, Wang XT. The application of Bailing capsule combined with MMF, prednisone and lamivudine on hepatitis B virus associated nephritis [J]. Chin Tradit Patent Med, 2010, 32(12): 1480-1482.
[27]
Liu ZH, Yuan F. Entecavir combined steroid therapy of clinical manifestations of nephrotic syndrome in HBV-GN [J]. Clin Res, 2008, 25(12): 2264-2266.
[28]
向慧,孙剑.来氟米特与霉酚酸酯治疗乙肝病毒相关性肾炎的疗效比较[J].临床医学工程,2011,18(2):213-215.
[29]
Fabrizi F, Dixit V, Martin P. Meta-analysis: anti-viral therapy of hepatitis Bvirus-associated glomerulonephritis [J]. Aliment Pharmacol Ther, 2006, 24(5): 781-810.
[30]
Nishi E, Kameda H, Ogawa H, et al. Efficacy of weekly mizoribine pulse therapy in refractory lupus nephritis [J]. Mod Rheumatol, 2013,23(1): 97-103.
[31]
Xie Y, Huang S, Wang L, et al. Efficacy and safety of mizoribine combined with losartan in the treatment of IgA nephropathy:a multicenter, randomized, controlled study [J]. Am J Med Sci, 2011, 341(5): 367-372.
[32]
Naka K, Ikeda M, Abe K, et al. Mizoribine inhibits hepatitis C virus RNA replication: effect of combination with interferon-alpha [J]. Biochem Biophys Res Commun, 2005, 330(3): 871-879.
[33]
袁琦.抗乙肝病毒治疗与抗乙肝病毒联合应用免疫抑制剂治疗乙肝相关肾炎的临床观察[D].吉林大学,2013.
[34]
Akimoto T, Otake T, Tanaka A, et al. Steroid treatment in patients with membranous nephropathy and hepatitis B virus surface antigenemia: a report of two cases [J]. Clin Exp Nephrol, 2011, 15(2): 289-293.
[35]
中华医学会.临床诊疗指南肾脏病学分册[M].北京:人民卫生出版社,2011:81-82.
[36]
许静云,丁樱.乙肝肾治疗经验介绍[J].光明中医,2010,25(3):394.
[37]
刘红,唐政.α-干扰素治疗慢性乙型肝炎及HBV相关性肾炎[J].肾脏病与透析肾移植杂志,1996,5(5):59-61.
[38]
骆丹. 霉酚酸酯联合拉米呋啶治疗乙肝病毒相关性肾炎30例临床分析[J]. 海军医学杂志,2009,30(2):114-116.
[39]
成彩联,娄探奇,郑振达,等. 霉酚酸酯联合激素及拉米夫定治疗乙肝相关性肾炎的观察[J]. 中国实用内科杂志,2005,25(12):1083-1085.
[40]
赵东,周清华. 乙肝相关性肾炎的治疗[J]. 中国病原生物学杂志,2008,3(11): 858-859,875.
[41]
张志勇,周春华,李明旭,等. 来氟米特联合激素治疗乙型肝炎病毒相关性肾炎的临床观察[J]. 第二军医大学学报,2006,27(10): 1152-1153.
[42]
薛晓霞,路凌,裴竹莲,等.来氟米特联合拉米夫定治疗合并乙肝病毒感染肾病综合征23例[J].陕西医学杂志,2009,38(7):873-874.
[43]
夏德全,蔡淑芳,杨焕荣,等.乙肝病毒相关性肾炎临床分析及拉米夫定联合来氟米特、泼尼松干预作用[J].中国医学创新,2009,6(9):6-8.
[44]
黄启功.乙型肝炎病毒相关性肾炎的治疗药物研究概述[J].中国临床研究,2013,26(7):726-727.
[45]
高鸣,胡江华.邵朝弟教授治疗乙型肝炎相关性肾炎的经验[J].中西医结合肝病杂志,2006,16(1):44-45.
[46]
占永立,杨丽萍.益气活血、清热利湿法治疗乙型肝炎病毒相关性肾炎的体会[J].中医杂志,2008,49(6):361-362.
[47]
荀蕾,马强,卢秉久.卢秉久教授治疗乙型肝炎病毒相关性肾炎蛋白尿的经验介绍[J].新中医,2009,41(2):12-14.
[48]
姚源璋,王晓光.肾脏病诊治[M].上海:上海科学技术出版社.2006:107-108.
[49]
姬焕珍.加味五苓散治疗小儿乙型肝炎相关性肾炎32例[J].陕西中医,2002,23(11):993-994.
[50]
钱海青.清热活血汤治疗乙型肝炎病毒相关性肾炎25例[J].浙江中医杂志,2002,37(8):330.
[51]
陶兴,冯松杰.益气养阴与健脾化湿利水法治疗乙肝相关性肾炎14例[J].中国中西医结合肾病杂志,2004,5(3):12.
[52]
陈建红,阎振武.氧化苦参碱治疗乙肝相关性肾炎疗效观[J].中国误诊学杂志,2007,7(21):4975-4976.
[53]
蓝健姿,张雪梅,严晓华,等.中西医结合治疗乙肝相关性肾炎36例[J].福建中医药,2005,36(6):33.
[54]
张冬云.中西医结合治疗乙型肝炎病毒相关肾炎临床研究[J].中国医药导刊,2009,11(3):377-379.
[55]
张明霞.拉米夫定联合玉屏风散治疗乙肝相关性肾炎的疗效[J].贵阳医学院学报,2011,36(5):505-507.
[56]
张伯鹏,赵艳,何淑宏,等.黄芪注射液联合拉米夫定治疗乙型肝炎相关性肾炎临床观察[J].河北中医,2008,30(5):523-525.
[1] 杨水华, 何桂丹, 覃桂灿, 梁蒙凤, 罗艳合, 李雪芹, 唐娟松. 胎儿孤立性完全型肺静脉异位引流的超声心动图特征及高分辨率血流联合时间-空间相关成像的应用[J]. 中华医学超声杂志(电子版), 2023, 20(10): 1061-1067.
[2] 衣晓丽, 胡沙沙, 张彦. HER-2低表达对乳腺癌新辅助治疗疗效及预后的影响[J]. 中华乳腺病杂志(电子版), 2023, 17(06): 340-346.
[3] 谭巧, 苏小涵, 侯令密, 黎君彦, 邓世山. 乳腺髓样癌的诊治进展[J]. 中华乳腺病杂志(电子版), 2023, 17(06): 366-368.
[4] 张伟. 牙及牙槽外科:舒适治疗的先锋[J]. 中华口腔医学研究杂志(电子版), 2023, 17(06): 386-388.
[5] 彭旭, 邵永孚, 李铎, 邹瑞, 邢贞明. 结肠肝曲癌的诊断和外科治疗[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 108-110.
[6] 马伟强, 马斌林, 吴中语, 张莹. microRNA在三阴性乳腺癌进展中发挥的作用[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 111-114.
[7] 陈垚, 徐伯群, 高志慧. 改良式中间上入路根治术治疗甲状腺癌的有效性安全性研究[J]. 中华普外科手术学杂志(电子版), 2023, 17(06): 619-622.
[8] 孔博, 张璟, 吕珂. 超声技术在复杂腹壁疝诊治中的作用[J]. 中华疝和腹壁外科杂志(电子版), 2023, 17(06): 670-673.
[9] 姜明, 罗锐, 龙成超. 闭孔疝的诊断与治疗:10年73例患者诊疗经验总结[J]. 中华疝和腹壁外科杂志(电子版), 2023, 17(06): 706-710.
[10] 袁媛, 赵良平, 刘智慧, 张丽萍, 谭丽梅, 閤梦琴. 子宫内膜癌组织中miR-25-3p、PTEN的表达及与病理参数的关系[J]. 中华临床医师杂志(电子版), 2023, 17(9): 1016-1020.
[11] 陆志峰, 周佳佳, 梁舒. 虚拟现实技术在治疗弱视中的临床应用研究进展[J]. 中华临床医师杂志(电子版), 2023, 17(08): 891-895.
[12] 李田, 徐洪, 刘和亮. 尘肺病的相关研究进展[J]. 中华临床医师杂志(电子版), 2023, 17(08): 900-905.
[13] 岳瑞雪, 孔令欣, 郝鑫, 杨进强, 韩猛, 崔国忠, 王建军, 张志生, 孔凡庭, 张维, 何文博, 李现桥, 周新平, 徐东宏, 胡崇珠. 乳腺癌HER2蛋白表达水平预测新辅助治疗疗效的真实世界研究[J]. 中华临床医师杂志(电子版), 2023, 17(07): 765-770.
[14] 周婷, 孙培培, 张二明, 安欣华, 向平超. 北京市石景山区40岁及以上居民慢性阻塞性肺疾病诊断现状调查[J]. 中华临床医师杂志(电子版), 2023, 17(07): 790-797.
[15] 符梅沙, 周玉华, 李慧, 薛春颜. 淋巴细胞免疫治疗对复发性流产患者外周血T淋巴细胞亚群分布与PD1/PD-L1表达的影响及意义[J]. 中华临床医师杂志(电子版), 2023, 17(06): 726-730.
阅读次数
全文


摘要