〔摘 要〕 目的：幽门螺杆菌（helicobacter pylori, Hp）感染与胃肠外疾病的关系日益受到重视。膜性肾病（membranous nephropathy, MN）是成人原发性肾病综合征的常见病理类型，其发生发展被认为与慢性感染有关。本文旨在探讨Hp感染与MN的关系，为临床诊疗提供相关依据。方法：选择2011年6月~2012年6月在解放军总医院肾病科住院、经临床和病理确诊的患者，分为MN组与对照组（IgA nephropathy, IgAN）。记录患者一般情况、临床表现，肾功能、24h尿蛋白定量及尿红细胞计数；Hp感染检测、肿瘤标志物。结果：MN患者中，Hp感染阳性患者尿蛋白定量较高；病理提示出现全球硬化、节段硬化、系膜细胞增殖和系膜基质增宽的比例均升高。有1例高泌乳素瘤患者随着肿瘤的好转MN减轻。结论：Hp感染阳性的MN患者尿蛋白及病理指标偏重；Hp感染可能在MN的发生中起一定作用，应积极寻找潜在的继发因素，建议把13C呼气试验作为MN患者继发因素的筛查方法之一。

ABSTRACT Objective: In recent years, the relationship between Helicobacter pylori (Hp) infection and memberanous nephropathy has been increasingly valued. MN is considered as the common pathological type of adult primary nephrotic syndrome, and its occurrence and development is correlated with chronic infection. We want to explore the relationship between Hp infection and MN. Methods: Select the patients hospitalized in PLA general hospital with clinical and pathologic examination In June 2011 to June 2012. It is divided into MN for the observation group and IgA nephropathy as that in the controls. Record the general condition, clinical manifestation, and 13C breath test for the detection of Hp. Determine renal function, 24-hour urine protein concentration (albuminuria) and tumor markers. Leave early morning urine to detect routine urine and urinary red blood cell counts. Record the renal biopsy. Results: The Hp infection rates of the two groups were significantly different (P<0.05), MN group is higher than control group. In MN patients, the positive Hp infection patients’ 24-hour urine protein concentration was slightly higher. There were also significantly pathologic higher with glomerular sclerosis of the global, segmental sclerosis, mesangial cell proliferation and widened mesangial matrix and so on in the positive Hp infection MN patients. There has been one tumor patient that MN was naturally better along with the treatment of tumor improved. Conclusion: Hp infection may be associated with MN. In MN patients, the positive Hp infection patients’ biochemistry and pathologic index are inclined to more severe. The significance of eradication of Hp infection in the positive Hp infection MN patients need more study. We should be actively looking for potential secondary factors of MN. 13Cbreath test can become one of the screening tests of MN potential secondary factors.