中文摘要：

目的观察儿童乙型肝炎病毒相关性膜性肾病（HBV-MN）肾组织的细胞凋亡情况,以探讨其在HBV-MN发病中的意义。方法采用活性Caspase-3免疫组织化学染色和核糖核苷酸末端转移酶介导的缺口末端标记法（TUNEL）观察HBV-MN患儿肾组织及正常肾组织中的凋亡现象,并分析其与肾组织病理改变、尿蛋白及临床免疫学指标等因素的关系。结果正常肾组织中,Caspase-3仅表达于少数肾小管上皮细胞胞质;在HBV-MN患儿的肾小球和肾小管-间质区,Caspase-3不仅表达于细胞质尚可见于胞核区（即活性Caspase-3）,且肾小球和肾小管-间质区活性Caspase-3的表达（凋亡指数）与TUNEL指数均显著相关。HBV-MN患儿肾组织的凋亡指数与肾脏病变病理分期显著相关。肾小球凋亡指数与蛋白尿程度相关,而与HBsAg的沉积强度、血清补体C3水平无相关性;肾小管-间质区凋亡指数与蛋白尿程度、尿视黄醇结合蛋白水平显著相关。结论HBV-MN患儿肾小球及肾小管-间质区均存在依赖Caspase-3的肾脏固有细胞凋亡,活性Caspase-3的表达与肾脏病变严重程度、临床蛋白尿水平及尿视黄醇结合蛋白（RBP）水平相关。肾脏固有细胞凋亡可能在HBV-MN的病理过程中发挥重要作用。

英文摘要：

Objective To study apoptosis in renal tissues of children with hepatitis B virus-associated membranous nephropathy（HBV-MN） and explore the significance of renal inherent cells apoptosis in the pathogenesis of HBV-MN. Methods The specific immunohistochemical staining of activated Caspase-3 protein and TUNEL method were used to recognize apoptosis cells in children with biopsy-proven HBV-MN and the patients with nephrolithiasis or kidney trauma（control group）. The correlation between apoptotic index with clinical, serological and pathologic data was analyzed. Results Caspase-3 protein expression was detectable in both cytoplasma and nuclei（activated Caspase-3） of glomerular cells and tubulointerstitial cells in HBV-MN, but only in cytoplasma of a few tubulointerstitial cells in controls. In glomeruli and tubulointerstitium, there was a good correlation between apoptosis index assessed by activated Caspase-3 staining and TUNEL index. The glomerular and tubulointerstitial apoptosis index was significantly correlated with pathologic severity of HBV-MN. Glomerular apoptosis index was higher in patients with massive proteinuria（≥50 mg/kg） than those with moderate proteinuria（〈50 mg/kg）. But it wasn＇ t correlated with serum levels of C3 and HBsAg deposition in glomeruli. Tubulointerstitial apoptosis index was significantly correlated with daily urine protein excretion and urine RBP levels. Conclusion All children with HBV-MN showed Caspase-3-dependent apoptosis of renal intrinsic cells in glomeruli and tubulointerstitium. Furthermore, the expression level of activated Caspase-3 was significantly correlated with renal pathologic severity, proteinuria and uric RBP level. Apoptosis of renal intrinsic cell may play an important role in the pathogenesis of HBV-MN in children.