肾移植受者BK病毒相关性肾病的临床诊断

目的 探讨肾移植受者BK病毒相关性肾病(BKVAN)的临床诊断方法 .方法 分别于肾移植术后第1、3、6、9、12个月收集90例肾移植受者血、尿标本,进行尿沉渣Decoy细胞计数与BK病毒(BKV)DNA含量的检测.应用免疫组织化学技术检测移植肾组织中的SV40-T蛋白,移植肾组织及确诊为BKVAN患者的尿沉渣中脱落的肾小管上皮细胞进行普通透射电镜观察.结果 90例肾移植受者1年内尿液Decoy细胞、BKV DNA及血浆BKV DNA阳性率分别为:42.2%(38/90)、45.6%(41/90)和22.2%(20/90);阳性者中位数水平分别为8个/10 HPF、2.60×10~5拷贝/ml和9.65×10~3拷贝/ml.确诊BKVAN 5例.结论 肾移植术后定期规律监测有关BKV活动的指标非常必要.确诊BKVAN需依靠普通病理染色与免疫组织化学染色或普通透射电子显微镜并结合临床表现.

Clinical diagnosis of BK virus associated nephropathy in renal transplant recipients

Objective To investigate the methods for clinical diagnosis of BK virus associated nephropathy(BKVAN)in renal transplant recipients.Methods Urine and peripheral blood(PB)were taken from90 renaltransplant recipients fo rBKV cytological testing and real-time PCR for BKV DNA at the post-transplantafion month 1,3,6,9,and 12.Graft biopsies were analysed for SV40-T by immunohistochemical method.Graft biopsies and urinary sediments of recipients with BKVAN were taken to momtor viral partieles by conventional transmission electron microscopy(EM).Results By one post-transplant year,urinary decoy cells(median,8/10 HPF),BKV viruria(mediall,2.60×10~5 copies/ml),viremia(median,9.65×10~3copies/ml).and BKVAN occurred in 42.2%,45.6%,22.2%,and 5.6%of patients,respectively.BKVAN was diagnosed in 5 calves.Conclusion Intensive and regular BKV monitoring is necessary for renal transplant recipients.The correct diagnosis of BKVAN depends on routine histopathological examination combined with immunohistochemistry or electron microscopy and the clinical manifestationa.