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目的观察α-干扰素治疗成人乙型肝炎病毒(hepatitisBvirus,HBV)相关肾炎的疗效。方法对1996-09~2003-03上海交通大学附属瑞金医院9例HBV相关肾炎患者予以α-干扰素治疗,300×104U隔日治疗,疗程6~9个月,观察治疗前后蛋白尿、血清HBV标志物和分支链DNA(branchedDNA,bDNA)等情况的变化。结果经治疗,患者尿蛋白排泄量显著减少(P<0·05);9例患者中,8例患者蛋白尿有不同程度的减少,24h尿蛋白减少量为0·55~9·50g,其中3例蛋白尿消失,4例肾病综合征缓解。9例患者乙肝表面抗原(HBsAg)均未转阴,6例乙肝e抗原(HBeAg)阳性者3例转阴。9例患者检测了血清HBVbDNA,8例患者bDNA下降伴蛋白尿好转,1例bDNA无好转伴持续大量蛋白尿。α-干扰素治疗成人乙肝病毒相关肾炎总有效率为78%,无明显不良反应。结论抗病毒药物α-干扰素治疗成人HBV相关肾炎具有一定效果。治疗有效者蛋白尿减少,体内病毒复制下降,由此证实病毒复制在HBV相关肾炎中的作用。
Objective To observe the therapeutic effect of interferon-alpha on adult hepatitis B virus (HBV) -related nephritis. Methods Nine patients with HBV-associated nephritis in Ruijin Hospital Affiliated to Shanghai Jiaotong University from September 1996 to March 2003 were treated with α-interferon and 300 × 104U every other day for 6 to 9 months. The proteinuria, serum HBV markers And branched-chain DNA (branchedDNA, bDNA) and other changes. Results After treatment, the urinary protein excretion was significantly decreased (P <0.05); among the 9 patients, the proteinuria of 8 patients decreased to some degree and the decrease of 24-h urine protein was 0. 55 to 9 · 50g 3 cases of proteinuria disappeared, 4 cases of nephrotic syndrome remission. None of the 9 patients had negative HBsAg, and 6 of 6 HBeAg positive patients turned negative. Serum HBVb DNA was detected in 9 patients, bDNA decline with proteinuria in 8 patients, and proteinuria in 1 patient without bRT. The total effective rate of interferon-alpha treatment of hepatitis B virus associated nephritis in adults was 78%, with no obvious adverse reactions. Conclusion Antiviral α-interferon treatment of HBV-related nephritis has some effect. Treatment-effective proteinuria decreased in vivo viral replication decreased, thus confirming the role of viral replication in HBV-related nephritis.