目的分析儿童乙型肝炎病毒相关性肾炎(HBV-GN)的临床及病理特点,探讨不同方案治疗的疗效和预后。方法总结1998年1月至2006年6月在北京大学第一医院儿科就诊的42例HBV-GN患儿的临床及病理特点,并对不同治疗方案的疗效进行统计学分析。结果(1)平均起病年龄(7.7±2.1)岁,从起病到确诊的平均时间为(6.2±3.8)个月;男女比例5.0∶1;有HBV家族史者21例;24例临床为肾病综合征,9例为肾炎综合征,8例蛋白尿伴血尿,1例孤立性蛋白尿。(2)实验室检查:42例均有蛋白尿(其中肾病水平蛋白尿28例),36例有血尿;13例cCr>120mL/(min.1.73m2)。30例(71.4%)为HBsAg+HBeAg+HBcAb阳性,3例(7.1%)HB-sAg+HBsAb+HBcAb阳性;17例有ALT升高;在34例行HBV-DNA检测患儿中,27例(79.4%)HBV-DNA阳性。(3)非典型膜性肾病30例,轻到中度系膜增生肾小球肾炎7例(其中IgA肾病3例),毛细血管内增生性肾小球肾炎3例,FSGS1例,轻微病变1例;23例肾组织免疫荧光呈“满堂亮”。(4)单纯抗病毒治疗组(A组):16例,仅接受干扰素和(或)拉米夫定治疗;其中12例随访≥6个月,9例缓解,1例部分缓解,2例无效;6例HBeAg阴转。抗病毒联合激素及免疫抑制剂治疗组(B组):14例,在干扰素和(或)拉米夫定基础上联合激素及免疫抑制剂治疗;10例随访≥6个月,2例完全缓解,2例部分缓解,6例无效(2例有肾功能异常);2例HBeAg阴转。失访12例。在蛋白尿缓解方面,A、B两组之间差别有统计学意义,提示A组疗效优于B组;在HBeAg阴转方面两组间差别无统计学意义。结论乙型肝炎病毒相关性肾炎多为学龄儿童起病,男多于女;临床起病隐匿,多为肾病水平蛋白尿伴血尿;以非典型膜性肾病为主要病理表现,半数病例肾脏组织免疫荧光染色呈“满堂亮”;单纯抗病毒治疗在蛋白尿缓解方面优于抗病毒联合激素及免疫抑制剂治疗;少数病例可进展为肾衰竭。 Objective To analyze the clinical and pathological features of hepatitis B virus associated nephritis (HBV-GN) in children and explore the curative effect and prognosis of different regimens. Methods From January 1998 to June 2006, the clinical and pathological features of 42 children with HBV-GN treated in the pediatrics department of Peking University First Hospital were analyzed. The curative effects of different treatment regimens were analyzed statistically. Results The average age of onset was (7.7 ± 2.1) years old, the average time from onset to diagnosis was (6.2 ± 3.8) months. The male / female ratio was 5.0:1. There were 21 cases with family history of HBV. The clinical stage was Nephrotic syndrome, 9 cases of nephritic syndrome, 8 cases of proteinuria with hematuria, 1 case of solitary proteinuria. (2) Laboratory examination: 42 cases had proteinuria (including 28 cases of nephropathy proteinuria), 36 cases had hematuria, and 13 cases had cCr> 120ml / (min.1.73m2). Thirty (71.4%) were positive for HBsAg + HBeAg + HBcAb, and 3 (7.1%) HBsAg + HBsAb + HBcAb were positive; ALT was elevated in 17 of them; (79.4%) HBV-DNA positive. (3) 30 cases of atypical membranous nephropathy, 7 cases of mild to moderate mesangial proliferative glomerulonephritis (including 3 cases of IgA nephropathy), 3 cases of capillary proliferative glomerulonephritis, 1 case of FSGS, 1 case of mild lesion Cases; 23 cases of renal tissue immunofluorescence was “full house”. (4) Simple antiviral therapy group (group A): 16 patients received interferon and / or lamivudine only; 12 patients were followed up for 6 months, 9 patients were relieved, 1 patient partially relieved, 2 patients Invalid; 6 cases of HBeAg negative conversion. Antimicrobial combination hormones and immunosuppressive therapy group (B group): 14 cases, on the basis of interferon and / or lamivudine combined with hormone and immunosuppressive therapy; 10 cases were followed up for 6 months, 2 cases completely Two cases were relieved, six cases were ineffective (two cases had renal dysfunction), and two cases had HBeAg negative conversion. Lost in 12 cases. In proteinuria remission, the difference between A and B groups was statistically significant, suggesting that the efficacy of group A was better than that of group B. There was no significant difference between the two groups in HBeAg negative conversion. Conclusions Hepatitis B virus-associated nephritis is mostly onset in school-age children, with more men than women; clinical onset is occult, mostly with nephropathy with proteinuria and hematuria; atypical membranous nephropathy is the main pathological manifestation. Fluorescent staining was “full house light”; simple antiviral therapy in proteinuria better than anti-virus combined with hormone and immunosuppressive therapy; a few cases can progress to renal failure.