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目的 :了解我国膜性肾病 (MN)、膜增殖性肾炎 (MPGN)的丙型肝炎病毒 (HCV)感染率 ,HCV感染与冷球蛋白血症及肾脏病变的关系 ,以期阐明 HCV在 MN及 MPGN中的作用。方法 :前瞻性观察 4 6例健康工作人员以及 1996年 5月至 1997年 11月期间 6 7例 MN,12例MPGN患者血清 HCV抗体 ,HCV- RNA的阳性率 ,血清冷球蛋白浓度及冷沉淀物中的 HCV抗体及 HCV- RNA阳性率 ,并结合肾组织 HCV抗原沉积特点进行分析。 结果 :1健康工作人员中无一例 HCV抗体或 HCV- RNA阳性者。 2 MN患者血清 HCV抗体 ,HCV- RNA的阳性率分别为2 .99%和 4 .4 8%。3例伴 HCV- RNA阳性的 MN临床都表现为肾病综合征 ,肝功能及补体正常 ,有2例存在冷球蛋白血症 ,病理上除表现为膜性病变外尚有较重的系膜增生。 MN伴血清 HCV- RNA阳性者肾组织 HCV- NS5抗原主要沉积于肾小球毛细血管袢和肾小管管型内。 3MPGN患者HCV抗体及 HCV- RNA均为阴性。 结论 :我国 MN,MPGN的 HCV感染率很低 ,6 7例 MN中有 3例血清 HCV- RNA阳性 ,其中 1例 HCV抗体同时为阳性 ,而 12例 MPGN中无一例 HCV感染者 ,与正常人群无明显差异。在血清 HCV- RNA阳性的 MN患者肾组织中检出 HCV- NS5抗原的存在 ,HCV在 MN、MPGN中的作用有待于进一步的研究证实。
Objective: To investigate the relationship between HCV infection and cryoglobulinemia and nephropathy in patients with membranous nephropathy (MN) and membranoproliferative glomerulonephritis (MPGN) in China in order to clarify the relationship between HCV infection in MN and MPGN In the role. Methods: We prospectively observed the serum HCV antibody, HCV-RNA positive rate, serum cryoglobuline concentration and cryoprecipitate in 46 healthy staffs and 67 patients with MN and 12 patients with MPGN from May 1996 to November 1997. HCV antibodies and HCV-RNA positive rate, and combined with renal deposition of HCV antigen characteristics were analyzed. Results: 1 None of the health workers had HCV antibody or HCV-RNA positive. The positive rates of HCV antibody and HCV-RNA in 2 MN patients were 2.99% and 4.48% respectively. 3 cases of HCV-RNA-positive MN clinical manifestations of nephrotic syndrome, liver function and complement normal, there are 2 cases of cryoglobulinemia, in addition to the pathological manifestations of membranous lesions, there are still serious mesangial proliferation . MN with serum HCV-RNA positive renal tissue HCV-NS5 antigen mainly deposited in glomerular capillary loop and tubular tubular type. 3MPGN patients with HCV antibodies and HCV-RNA were negative. CONCLUSIONS: The prevalence of HCV infection in MN and MPGN is very low in our country. Serum HCV-RNA was positive in 3 out of 67 MNs, of which 1 HCV antibody was positive at the same time, and none of the 12 MPGN HCV infected patients was associated with normal population No significant difference. The detection of HCV-NS5 antigen in the serum of HCV-RNA-positive MN patients and the role of HCV in MN and MPGN need to be confirmed by further studies.