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각종 신질환에서 혈청 B형 간염 표면 항원(HBsAg) 의 발현 빈도
한대석,최인준,이호영,정석호,신성태,우은균 대한신장학회 1984 Kidney Research and Clinical Practice Vol.3 No.2
Overall incidence of positive serum hepatitis-B antigen in Korean adult population is exceptio- nally higb with a positive rate of about 12%. In view of development of certain types of glome- rular diseases, especially membranous glomerulo- pathy in children associated with chronic hepa- titis-B infection presumably mediated by immune complex deposition, we studied the incidence rate of positive serum HBsAg and anti-HBs in 304 adult patients with various glomerular diseases and chronic renal failure evaluated at the Seve- rance Hospital, Yonsei University Medical Center during the period beginning from Jan. 1979 till Dec. 1983. As a control group, 2,634 subjects with no clinical and laboratory evidences of renal diseases were studied. 1) Serum hepatitis-B surface antigen was posi- tive in 52 patients out of 304 renal patients(17. 1 %)while the positive rate for normal control population was 12.3%. This difference was sta- tistically signifieant(p(0. 01). 2) Incidence rate for positive serum anti-HBs in patient and control group was not significantly different; 34.8,o (94/269) and 40.4%(639/1583) respectively. 3) As a group, patients with tiopsy proven nephrotic syndrome from various primary glome- rular diseases showed the highest positive incide- nce rate of HBsAg(24. 1%) compared to the patients with chronic renal failure(8. 9%) or chronic glomerulonephritis(18.6%). The positive inclidence rate in nephrotic patients was sign- ificantly higher than that of control group(p$lt;0.01). 4) Biopsy proven patients with membranous nephropathy(MN) and membranoproliferative glo- merulonephropathy(MPGN) showed significantly higher positive incidence rate for serum HBsAg compared to the normal control group(p$lt;0. 025, p$lt;0. 005). In patients with MN and MPGN, 35. 3 %(6/17) and 42. 6,o(12/28) was positive at the time of renal biopsy. Patients with minimal change lesion and focal sclerosis showed positive incidence rate of 18. 8% and 0% which were not significantly different from normal group. 5) Incidences of positive serum anti-HBs in the patients with various glomerular diseases and chronic renal failure were not different significa- ntly from the control group except a lower rate (23%), observed in the patients with minimal change lesion nephrotic syndrome(p$lt;0. 005). Our data are discussed within the concept that chronic carrier state of hepatitis-B surface antigen can lead to the development of certain types of glomerular diseases in adults, particularly memb- ranous nephropathy and membranoproliferative glomerulonephropathy. Further studies are nece- ssary to prove this important manifestations of hepatitis-B viral infection.