摘要目的:通过对肾组织伴有或无乙型肝炎病毒(HBV)抗原沉积的老年患者的临床和病理资料进行对比分析，进一步探讨老年乙肝相关性肾炎的临床和病理特点。方法:对联勤保障部队第九〇〇医院年龄≥60岁的33例乙肝相关性肾炎(HBV-GN)和27例乙肝合并肾炎(HBV-CG)患者的临床、病理资料进行回顾性分析及统计学比较。结果:(1)两组均以男性[26例(78.8%)和21例(77.8%)]多见，临床表现均以肾病综合征[18例(54.5%)和15例(55.6%)]为主，其中HBV-GN组合并高血压者明显多于HBV-CG组；(2)两组均以膜性肾病(MN)为主要病理类型，其中HBV-GN组病理类型为膜增生性肾小球肾炎(MPGN)者明显多于HBV-CG组；(3)HBV-GN组在"大三阳"及高病毒载量者所占比例上均明显高于HBV-CG组；(4)HBV-GN组肾组织可观察到多种免疫复合物沉积的现象，即"满堂亮"；(5)HBV-GN组病理改变不同于HBV-CG组之处：具有不典型MN的表现；各病理类型肾组织中偶可观察到新月体形成；局灶节段肾小球硬化(FSGS)中可有基底膜增厚的表现；(6)HBV-GN组在肾小管及间质病变的发生率及病变程度上均明显高于HBV-CG组。结论:尽管老年HBV-GN与HBV-CG在临床表现及检验指标上有诸多相似之处，但HBV-GN者在血清病毒学及病理改变上仍与HBV-CG者存在较大的区别。因此对于该类老年患者，应重视血清HBV复制及肾脏病理改变情况，进而为治疗提供临床依据。

abstractsObjective:To compare and analyze the clinicopathological data of elderly patients with versus without hepatitis B virus(HBV)antigen deposition in renal tissue, and to investigate the clinicopathological features in elderly patients with HBV associated nephritis(HBV-GN).Methods:The clinicopathological data of 33 patients with HBV-GN and 27 patients with hepatitis B and nephritis(HBV-CG)aged ≥60 years in the 90 th Hospital of the United Nations Support Force were retrospectively analyzed and statistically analyzed. Results:(1)Both the HBV-GN and HBV-CG groups were often men[26(78.8%) vs. 21(77.8%)]and had high rate of nephritic syndrome[18(54.5%) vs.15(55.6%)]. And patients in the HBV-GN group had higher incidence of hypertension than that in the HBV-CG group; (2)Membranous nephropathy(MN)was the main pathological type in both groups, and the rate of membrane proliferative glomerulonephritis(MPGN)was more found in the HBV-GN group than the HBV-CG group; (3)The proportion positive HBsAg, HBeAg and HBcAb test resultsand high viral load was significantly higher in the HBV-GN group than that in the HBV-CG group; (4)Multiple immune complex deposits were observed in the renal tissues of HBV-GN group, which was called the phenomenon of "all bright" ; (5)The pathological features in the HBV-GN group showed untypical manifestation of MN, the occasionally observed crescent formation, and the thickening of basement membrane in focal segmental glomerulosclerosis; (6)The incidence and the severity of renal tubule and interstitial lesions in HBV-GN group were significantly higher than those in HBV-CG group. Conclusions:Although there are many similarities in clinical manifestations and testing indicators between the elderly HBV-GN and HBV-CG patients, HBV-GN patients are still significantly different from HBV-CG patients in terms of serum virology and pathological changes.Therefore, we should pay attention to the serum HBV replication and renal pathological changes to provide a clinical basis for treating this kind of elderly patients.