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目的:探讨乙型肝炎病毒(HBV)X基因突变在乙肝相关性膜性肾病(HBV-MN)M型磷脂酶2受体(PLAn 2R)表达以及可能的致病机制研究。n 方法:由肾穿刺活检证实的HBV-MN的患者103例，根据肾组织PLAn 2R免疫荧光检测结果分为2组，PLAn 2R阳性组66例，PLAn 2R阴性组37例。采用n t检验比较两组间的临床生化指标；根据HBV-MN病理分期的不同，MNⅠ期(病理损伤较轻)和MNII-Ⅲ期(病理损伤重)，采用One-way ANOVA单因素方差分析比较两组间肾脏病理损伤；Spearman相关分析比较PLAn 2R表达强度与肾脏病理损伤的差别；最后分析两组患者HBx基因突变位点。n 结果:两组患者24 h尿蛋白定量差别具有统计学意义(n t＝2.803，n P＝0.006)；而血白蛋白水平(n t＝-0.313，n P＝0.755)、血肌酐(n t＝-0.332，n P＝0.741)、胆固醇(n t＝0.312，n P＝0.756)、补体C3(n t＝0.589，n P＝0.557)差别无统计学意义。MNⅠ期在两组所占比例差别具有统计学意义(n X2＝7.449，n P＝0.006)；MNII-Ⅲ期两组差别同样具有统计学意义(n X2＝10.15，n P＝0.034)；其次，将PLAn 2R阳性组根据不同PLAn 2R荧光染色强度与不同MN病理分期行Spearman相关性分析，差别具有统计学意义(n r＝0.325，n P＝0.008)。最后，分析两组间HBx基因序列突变，发现nt1753位点突变可能与PLAn 2R表达相关。n 结论:研究中2/3的HBV-MN患者存在肾组织PLAn 2R阳性表达，PLAn 2R阳性组患者伴有尿蛋白排泄量增多以及肾脏病理损伤加重；同时，HBx基因中nt1753位点突变与PLAn 2R的表达相关，可能是PLAn 2R阳性HBV-MN重要的发病机制。n “,”Objective:To investigate the expression of HBV X, gene mutation in M type phospholipase 2 receptor (PLAn 2R) in hepatitis B associated membranous nephropathy (HBV-MN) and its possible pathogenesis.n Methods:According to the result of PLAn 2R immunofluorescence detection in renal tissue, 103 patients with HBV-MN confirmed by renal biopsies were divided into two groups: PLAn 2R positive group (n=66) and PLAn 2R negative group (n=37). T test was used to compare the clinical biochemical measurements between the two groups. According to MN I stages (mild pathological injury) and MN II-III stage (severe pathological injury) of HBV-MN pathological stage, One-way ANOVA analysis was used to compare the pathological injury of kidney between the two groups. Spearman correlation analysis was used to compare the expression intensity of PLAn 2R and pathological injury of kidney. Finally, the mutation sites of HBx gene in the two groups were analyzed.n Results:There was significant difference in 24 h urinary protein between the two groups (n t=2.803, n P=0.006). However, there was no significant difference in serum albumin level (n t=-0.313, n P=0.755), serum creatinine (n t=-0.332, n P=0.741), cholesterol (n t=0.312, n P=0.756) and complement C3 (n t=0.589, n P=0.557) between the two groups. There was significant difference between the two groups in MN stage I (n X2=7.449, n P=0.006) and MN stage II-III (n X2=10.15, n P=0.034). Secondly, the correlation analysis of Spearman between PLAn 2R staining intensity and different MN pathological stages was statistically significant (n r=0.325, n P=0.008). Finally, the mutation of HBx gene sequence between the two groups was analyzed, and it was found that the mutation at nt1753 site might be related to the expression of PLA2R.n Conclusions:The positive expression of PLAn 2R in renal tissue was found in 2/3 HBV-MN patients. The PLAn 2R positive group was accompanied by the increase of urinary protein excretion and the aggravation of renal pathological injury. At the same time, nt1753 site mutations in HBx gene are related to the expression of PLAn 2R, which may be an important pathogenesis of PLAn 2R positive HBV-MN.n