B型肝炎病毒感染的腎臟表現 - tsim.org.tw

1 2012 23 183-191. B . 1 2 3 1. 1 2 3 .. B (hepatitis B virus, HBV) . (membranous glomerulonephritis, MGN) (membranopro- liferative glomerulonephritis, MPGN) A (immunoglobulin A nephropathy, IgAN) (focal segmental glomerulosclerosis, FSGS) B .. B (HBsAg) . (anti-HBc) (HBeAg) . HBV ( HBeAg) . B . B .. (interferon) (lamivudine) 2010 2011. HBeAg . B .. B (Hepatitis B virus). (Glomerulonephritis). (Membranous glomerulonephritis). (Interferon). (Lamivudine). 10% . (25-90%)1 . B B . (hepatitis B virus, HBV) 5% B. B 2-11 . (HBsAg) 10-15% B Combes et al. 407 160 . 183-191-1087 183 2012/7/6 09:33:19. 184 . 1971 (indirect immuno- B . uorescence) B 30-40%.

2 12. (membranous glomerulone- B . phritis, MGN) B 40. Takekoski et al. 1979 B 90% B . 15-20% 16,17 B . B (HBeAg) IgG . 13. 1C B .. (membranoproliferative glomerulonephritis, MPGN) . (polyarteritis 18 B . nodosa, PAN) A (anti-HBs) . (immu-noglobulin A nephropathy, IgAN) HBeAg . (focal segmental glomerulosclerosis, HBeAg . 14, 15. FSGS) B DNA . 19 . B .. B . B . B . (DNA virus) T . B (HBsAg) B . HBsAg 14 . B .. (MGN) B HBeAg . 2 . (MPGN) MPGN B idiopathic MPGN . 50% 10 3,4 . HBsAg . (PAN) B 1-5% PAN PAN HBV. 5 .. (CG) C B 74%CG . HBV 6 . A B IgAN HBV ( . (IgAN) HBcAg, HBsAg )7,9 10 . (FSGS) 11,15 .. (membranous glomerulonephritis, MGN) (membranoproliferative glomerulone-phritis, MPGN) (polyarteritis nodosa, PAN) (cryoglobulinemia, CG) A.

3 (immunoglobulin A nephropathy, IgAN) (focal segmental glomerulosclerosis, FSGS) . 183-191-1087 184 2012/7/6 09:33:19. B 185. 8 DNA27 He et al.. B . HBV DNA 43 41. B ( ) HBV DNA . 20. B . 21, 22 23. (HBsAg) (HBeAg) . 24. (HBcAg) HBV DNA . (subepithelial region) HBV DNA 28 . B B. (mesangial and subendothelial areas) B . 5. HBeAg (3 10 Da) . 29 Lin 25 Lai et al. 100 et al. B . B 39 (Hepatitis B virus associated membranous nephro- B pathy, HBVMN) T . 26. HBeAg B HBeAg HBsAg B . (anti-HBs) 30 . HBsAg T HBcAg HBVMN . A T (Th-1 cell) . HBsAg HBcAg IL-2 IFN- . 8. Lai et al. HBcAg . (in situ hybridization) B HLA. HBV . / . B . ( HBsAg ).. 1.

4 ( HLA DQB1*0603 . T . DQB1*0303) Th-1 IL-2 IFN- . 2.. HBV . B 14 . 183-191-1087 185 2012/7/6 09:33:19. 186 . typing B HLA DQB1*0603 43%34 B . DQB1*0303 B . 31.. B B .. B B . 32 Gilbert B B RD et al. 37 B . 90 HBeAg 33 . 32. 35 95%. B 14 . HBeAg . B . B 33. 8 . HBV DNA . HBV ( HBsAg ) B. B . B . B . B . B B . (57%) . 8.. B . (54%) . B 33.. B . HBV . -- .. (>80%) (>50%). 5-7 .. B . AIDS . (>85%) . IgA . 95% 25% . 183-191-1087 186 2012/7/6 09:33:20. B 187. (lamivudine) HBeAg 30% . (entecavir) (telbivudine) 48 B . (adefovir) (tenofovir) . (interferon) . 49-51 . B . 100 . 36,37. 12 . B 23% . 65%52, 53 Lai . Zhang 2008 B .. 38. 54 . (n=159).

5 2,34,39-42 34,42-45. (n=70) (entecavir) (tenofovir) . 55 . ( = 95% . p= ) HBeAg ( 57 Ikee 58 57 B . = 95% B . p< ) B DNA . HBeAg (p= ) . B . ( = 95% . p= ) . HBeAg .. Yi B Fanconi 59 Marcellin . 102 . 1997 2010 ( 159 . ) Zhang 60 B . 46 .. (telbivudine) . (tenofovir) . Hossein 119 B .. 47 . B B . B B . (pegylated . interferon- 2a) . 183-191-1087 187 2012/7/6 09:33:20. 188 . HBsAg 6 .. ( ).. HBeAg HBsAg HBcAg . >3 / 3 / . B B B .. ( ) . HBeAg HBeAg . ( ( . HBV DNA HBV DNA <. 20,000 IU/ml) 2,000 IU/mL).. ? .. ( ). B . ( ) HBeAg, anti-HBe, HBV DNA, (alpha-fetoprotein, AFP) (total bilirubin, Bil-T), (prothrombin time, PT) . ( ) B . (PT 3 Bil-T 2mg/dL) ALT (alanine aminotransferase).

6 B . HBV DNA 20,000 IU/mL (HBeAg (+) ) 2,000 IU/mL (HBeAg(-) ) . 1 3 ALT . B . ( ) B ( ) .. B . B B .. B . 183-191-1087 188 2012/7/6 09:33:20. B 189. B 2009; 13: 373-7. 16. Sung JL. Hepatitis B virus infection and its sequelae in Taiwan. Gastroenterol Jpn 1984; 19: 363-6. 17. Chen DS, Sung JL. Hepatitis B virus infection on Taiwan. N. Engl J Med 1977; 297: 668-9. 18. Maynard JE, Kane MA, Hadler SC. Global control of hepatitis B through vaccination: role of hepatitis B vaccine in the Expanded Programme on Immunization. Review of Infectious Diseases 1989; 11: S574. 19. Johnson RJ, Couser WG. Hepatitis B infection and renal 1. Lai CL, Ratziu V, Yuen M-F, Poynard T.

7 Viral hepatitis B. disease: clinical, immunopathogenetic and therapeutic Lancet 2003; 362: 2089-94. considerations. Kidney Int 1990; 37: 663-76. 2. Lai KN, Li PKT, Lui SF, et al. Membranous Nephropathy 20. Chen L, Wu C, Fan X, et al. Replication and infectivity of Related to Hepatitis B Virus in Adults. N Engl J Med 1991; hepatitis B virus in HBV-related glomerulonephritis. Int J. 324: 1457-63. Infect Dis 2009; 13: 394-8. 3. Abbas NA, Pitt MA, Green AT, Solomon LR. Successful 21. Lai KN, Lai FM, Tam JS. IgA nephropathy associated with treatment of hepatitis B virus (HBV)-associated chronic hepatitis B virus infection in adults: the pathogenetic membranoproliferative glomerulonephritis (MPGN) with role of HBsAG.

8 J Pathol 1989; 157: 321-7. alpha interferon. Nephrol Dial Transplant 1999; 14: 1272-5. 22. Michalak T. Immune complexes of hepatitis B surface 4. Schmitt H, Bohle A, Reineke T, Mayer-Eichberger D, antigen in the pathogenesis of periarteritis nodosa. A study of Vogl W. Long-term prognosis of membranoproliferative seven necropsy cases. The Am J Pathol 1978; 90: 619. glomerulonephritis type I. Nephron 1990; 55: 242-50. 23. Hirose H, Udo K, Kojima M, et al. Deposition of hepatitis B. 5. Han SH. Extrahepatic manifestations of chronic hepatitis B. e antigen in membranous glomerulonephritis: Identi cation Clin Liver Dis 2004; 8: 403-18. by F (ab') 2 fragments of monoclonal antibody.

9 Kidney Int 6. Levo Y, Gorevic P, Kassab H, Zucker-Franklin D, Franklin 1984; 26: 338-41. E. Association between hepatitis B virus and essential mixed 24. Zhou S, Zhang Y, Guo M, et al. The study of the signi cance cryoglobulinemia. N Engl J Med 1977; 296: 1501-4. of the appearance of HbcAg in glomerulonephritis. Chin J. 7. Wang NS, Wu ZL, Zhang YE, Liao LT. Existence and Nephrol 1995; 11: 104-6. significance of hepatitis B virus DNA in kidneys of IgA 25. Bhimma R, Coovadia HM, Kramvis A, Adhikari M, Kew nephropathy. World J Gastroenterol 2005; 11: 712-6. MC, Connolly CA. HBV and proteinuria in relatives and 8. Lai KN, Lai FM, Chan KW, Chow CB, Tong KL, contacts of children with hepatitis B virus-associated Vallance-Owen J.

10 The clinico-pathologic features of hepatitis membranous nephropathy. Kidney Int 1999; 55: 2440-9. B virus-associated glomerulonephritis. Q J Med 1987; 63: 26. Lai F, Lai KN, Tam JS, Lui SF, To KF, Li P. Primary 323-33. glomerulonephritis with detectable glomerular hepatitis B. 9. Lai KN, Lai FM, Lo S, Ho CP, Chan KW. IgA nephropathy virus antigens. Am J Surg Pathol 1994; 18: 175. associated with hepatitis B virus antigenemia. Nephron 1987; 27. Lai KN, Ho RT, Tam JS, Lai FM. Detection of hepatitis B. 47: 141-3. virus DNA and RNA in kidneys of HBV related glomerulo- 10. Iida H, Izumino K, Asaka M, Fujita M, Takata M, Sasayama nephritis.