肾移植受者BK病毒感染的单中心回顾性研究

doi:10.3969/j.issn.1006-7795.2015.03.024

摘要/Abstract

摘要：

目的通过对肾移植术后受者的血清和尿液中BK病毒(BK virus, BKV) DNA拷贝数量的检测,探讨肾移植受者术后BK病毒的发病规律及其与临床转归的关系.方法对接受同种异体肾移植术的80例患者进行血清和尿液中BK病毒DNA拷贝数量的检测,利用SV40大T抗原免疫组化染色,对接受移植肾穿刺活检的80例病理学标本进行回顾研究, 对诊断BK病毒相关性肾病 (BK virus associated nephropathy, BKAVN)患者进行随访及病史复习.结果 BK病毒血症发生率为8.75%,BK病毒尿症发生率为37.5%,BKAVN发生率为2.5%,术后尿和血BK病毒DNA拷贝的变化趋势一致,术后6~12个月是BK病毒感染高峰期.结论 BKV感染对肾移植的效果有重要的影响,一旦出现BKVAN极易导致移植肾功能丧失;对肾移植受者应该进行BKV早期监测,减少免疫抑制剂的剂量治疗BKVAN的效果较好.

关键词: 肾移植, BK病毒, BK病毒相关性肾病, 移植肾功能减退

Abstract:

Objective To explore the incidence and clinical course of BK virus by monitoring of BKV loads in renal transplantation. Methods There are 80 cases of renal transplant recipients were undertaken BK virus detection including urine and serum BKV DNA. To demonstrate the BK virus replication. BKVAN was diagnosed by light microscopic examination and a positive immunohistochemistry staining of anti-SV40 large T antibody in a biopsy specimen. Patients diagnosed with BKVAN were followed up and medical case histories were reviewed. Results Among the 80 patients, BKV viruria, BKV viremia and BKVAN occurred in 37.5%, 8.75% and 2.5% of kidney transplant recipients, respectively. The BKV DNA level in urine and serum remained constant and the peak time of BKV infection was at the sixth month to twelfth month post renal transplantation. Conclusion BKVAN in renal transplant recipients is an important cause of renal transplant dysfunction. Routine BK virus surveillance is effective; It tends to detect BK virus replication early, allowing reduction of immunosuppression, which results in good outcomes with renal preservation.

Key words: kidney transplantation, BK virus, BK virus associated nephropathy, allograft dysfunction

中图分类号:

R617

杨晓勇, 任亮, 王玮, 刘航, 胡小鹏, 张小东. 肾移植受者BK病毒感染的单中心回顾性研究[J]. 首都医科大学学报, 2015, 36(3): 459-464.

Yang Xiaoyong, Ren Liang, Wang Wei, Liu Hang, Hu Xiaopeng, Zhang Xiaodong. Prospective study of BK virus infection in renal transplant recipients in a single-center[J]. Journal of Capital Medical University, 2015, 36(3): 459-464.

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