| BK多瘤病毒在肾移植受者中的感染特征 |
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| 引用本文： | 周易,姚雷雨,于哲,崔乃千,符芳翔,叶悦典,邓文锋,徐健,付绍杰,刘如敏,于立新,苗芸. BK多瘤病毒在肾移植受者中的感染特征[J]. 南方医科大学学报, 2019, 39(1): 120. DOI: 10.12122/j.issn.1673-4254.2019.01.19 |
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| 作者姓名： | 周易 姚雷雨 于哲 崔乃千 符芳翔 叶悦典 邓文锋 徐健 付绍杰 刘如敏 于立新 苗芸 |
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| 作者单位： | 南方医科大学第一临床医学院,广东 广州,510515;南方医科大学南方医院器官移植科,广东 广州,510515 |
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| 基金项目： | 国家自然科学基金;广东省高等教育学会高等教育科学研究十三五规划重点调研课题;广州市科技计划;南方医科大学大学生创新创业训练项目;南方医科大学大学生创新创业训练项目;南方医科大学南方医院院级教育课题;南方医院院长基金;南方医院院长基金 |
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| 摘 要： | 目的探讨肾移植受者术后BK多瘤病毒的感染特征和干预时机。方法回顾性分析2013年1月~2018年1月在本中心检测尿液BKV载量≥1.0×104 copy/mL的157例肾移植受者的临床资料，选择69例同期接受移植且尿液BKV载量始终<1.0×104 copy/mL肾移植受者作为对照。结果157例BKV感染再激活受者中出现尿BKV阳性60例（38.2%）、BKV尿症66例（42.0%）、BKV血症31例（19.7%）。BKV阳性患者与BKV阴性患者相比，尿隐血阳性率更高，差异有统计学意义（P<0.05）。受者尿液BKV载量变化率与他克莫司谷值血药浓度变化率呈正相关（r2=0.351, P<0.05）。首次发现BKV再激活时，BKV阳性患者平均eGFR低于基线水平（eGFR=60 mL/min·1.73 m-2）。干预后至末次随访，尿BKV阳性组平均eGFR可恢复至正常值，BKV尿症组和BKV血症组肾功能有所改善但均未达到基线水平。结论肾移植术后部分受者尿隐血阳性与BKV再激活状态相关，BKV载量对免疫抑制剂血药浓度的改变敏感。在BKV复制早期进行干预，适度减少免疫抑制剂剂量，能够有效控制BKV复制、维持移植肾功能。
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| 关 键 词： | 肾移植 BKV 尿隐血 免疫抑制剂 干预 |
Characteristics of BK polymavirus infection in kidney transplant recipients |
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| Abstract: | Objective To analyze the characteristics of BK polymavirus (BKV) infection and the optimal time window forintervention in kidney transplant recipients (KTRs). Methods We retrospectively analyzed the clinical data and treatmentregimens in 226 KTRs in our center between January, 2013 and January, 2018. Among the recipients, 157 had a urine BKVload ≥1.0×104 copy/mL after transplantation, and 69 had a urine BKV load below 1.0×104 copy/mL (control group). ResultsAmong the 157 KTRs, 60 (38.2%) recipients were positive for urine BKV, 66 (42.0%) had BKV viruria, and 31(19.7%) had BKVviremia. The incidence of positive urine occult blood was significantly higher in BKV-positive recipients than in the controlgroup (P<0.05). The change of urine BKV load was linearly related to that of Tacrolimus trough blood level (r2=0.351, P<0.05). Inurine BKV positive group, the average estimated glomerular filtration rate (eGFR) was below the baseline level (60 mL· min-1 ·1.73 m-2) upon diagnosis of BKV infection reactivation, and recovered the normal level after intervention. In patients with BKVviruria and viremia, the average eGFR failed to return to the baseline level in spite of improvement of the renal function afterintervention. Conclusion Positive urine occult blood after transplantation may be associated with BKV infection reactivation insome of the KTRs. BKV infection is sensitive to changes of plasma concentration of immunosuppressive agents. Earlyintervention of BKV replication in KTRs with appropriate dose reduction for immunosuppression can help to control virusreplication and stabilize the allograft function. |
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