影响肾移植受者BK病毒感染的危险因素分析

目的 探讨影响肾移植受者BK病毒(BKV)感染的危险因素.方法 选取2006年3月至2007年3月间进行肾移植术的90例受者为研究对象,分别于肾移植术后第1、3、6、9、12个月收集血、尿标本,进行尿沉渣Decoy细胞计数与BK病毒DNA含量的检测,对部分肾移植受者进行移植肾活检.根据尿液BKV DNA是否阳性分成BKV感染组与非感染组.比较2组受者在年龄、性别、术前有无糖尿病、是否为活体肾移植、是否使用抗白细胞介素-2受体单克隆抗体进行诱导、围手术期是否使用多克隆抗体及抗CD3单克隆抗体、术后免疫抑制剂方案、术后是否发生急性排斥反应、移植肾功能恢复延迟及肺部感染等临床指标的差异,应用Logistic回归法分析筛选BKV感染的危险因素.结果 90例肾移植受者尿液Decoy细胞、尿BKV DNA及血BKVA DNA的阳性率分别为42.2%(38/90)、45.6%(41/90)和22.2%(20/90).BKV感染组应用他克莫司(FK506)加霉酚酸酯(MMF)方案的比例为68.3%(28/41),明显高于BKV非感染组40.8%(20/49,P＜0.01).FKS06加MMF的免疫抑制方案是影响肾移植受者BKV感染的独立危险因素(X2=6.579,P=0.01,OR=3.123).确诊BKV相关性肾病(BKVAN)5例.结论 FK506加MMF的组合免疫抑制方案易发生BKV活化及BKVAN,术后受者需进行密切观察并进行相关检测.

Analysis on BK virus infection related factors in renal transplant recipients

Objective To analyze the risk factors affecting BK virus(BKV)infection after kidney transplantation.Methods Taking 90 renal recipients as objectives,urine and peripheral blood (PB)samples of which were taken for the BKV cytologieal test of urinary sediment and real-time PCR tests for BKV DNA of both urine and PB at 1,3,6,9 and 12 months after transplantation.Part of the renal-recipients had been received the graft biopsy.According to BKV DNA in urine,90 recipients were divided into two groups:BKV infected group and non-BKV infected group.Potential variables were compared between the two groups and analyzed by Logistic regression model multivariate analysis to assess and rank the BKV infection related factors.Results The positive rates of urine decoy cell,BKV viruria and viremia in 90 renal recipients were 42.2%(38/90),45.6%(41/90)and 22.2%(20/90),respectively.The proportion of the recipients who used FK506+MMF protocol in the BKV infected group was 68.3%(28/41),which was higher than that of the non-BKV infected group 40.8%(20/49,P＜0.01).Using FK506+MMF protocol was the independent risk factor impacting on BKV infection in renal recipients(X2=6.579,P=0.01,OR=3.123).Five cases of BK virus associated nephropathy(BKVAN)were diagnosed.Conclusion Using FK506+MMF can increase the possibility of BKV infection and then result in BKVAN in renal transplant recipients,intensively BKV monitoring is necessary for these recipients.