肾移植术后BK病毒感染的危险因素分析

目的 分析肾移植术后BK病毒(BKV)感染发生的危险因素.方法 应用荧光实时定量PCR技术检测129例肾移植患者血液中BKV并行尿液细胞学检查,记录BKV-DNA阳性及阴性组患者性别、年龄、供肾冷缺血时间,术前血液透析时间、急性排斥反应、是否发生移植肾功能延迟恢复、免疫抑制剂方案、合并其他病毒感染等指标.应用二项多元逻辑回归法分析肾移植术后BKV感染发生的危险因素.结果 129例患者血中BKV-DNA阳性20例(15.5%).阴性109例(84.5%);BKV-DNA阳性患者尿细胞学检测Decoy细胞阳性15例,尿Decoy细胞阳性率与血BKV-DNA阳性率之间有明显的相关性(r=0.428,P<0.01).回归分析结果 显示:供肾冷却血时间(χ~2=9.243,95%CI:1.099～1.545,P<0.05)、患者术前透析时间(χ~2=7.599,95%CI:1.038～1.243,P<0.05)、是否为亲体供肾(χ~2=4.150,95%CI:0.012～0.070,P<0.05)为BKV感染的危险因素.结论 荧光实时定量PCR及尿细胞学检查可以作为肾移植术后BKV感染的筛查指标;供肾冷缺血时间长、术前血液透析时间长、尸体供肾均可增加患者术后BKV感染的风险.

Risk factors of BK virus infection post renal transplantation

Objective To analyze the risk factors of BKV infection and compare the real-time PCR procedure and urinary sediment smears of patients checked for decoy cells. Methods The peripheral blood samples of 129 renal recipients were collected. According to the result of PCR, 129 patients were divided into 2 groups:①BKV-DNA(+);②BKV-DNA(-). The sex, age, cold ischemia time, hemotodialysis duration, immunosuppressive agent and other clinical parameters were compared between the 2 groups and a Logistic regression was performed to analyze the risk factors of BKV infection. Results There were 20(15. 5%) patients in BKV-DNA(+), 109(84. 5%)patients in BKV-DNA(-)group. Logistic regression found that the cold ischemia time, hematodialysis duration, living donor were significantly related to the BKV-DNA. The results of the real-time PCR procedure and urinary sediment smears of patients checked for decoy cells were related. Conclusion Real-time fluorescent quantitative PCR and urine decoy cell are good way for detection of BKV infection after renal transplantation. The cold ischemia time and hematodialysis duration and brain death donor were the risk factors of BKV infection post renal transplantation.