肾移植术后受者BK病毒血症的高危因素分析

背景：肾脏移植的受者BK病毒感染相关性肾病可引起移植肾功能不全和输尿管梗阻，是移植肾失功的重要原因之一。 目的：检测肾移植患者后BK病毒血症的发生率，分析BK病毒感染的危险因素。 设计、时间及地点：回顾性病例分析，于2001-09/2007-12首都医科大学附属北京友谊医院泌尿外科完成。 对象：因终末期肾病而进行同种异体肾移植患者121例，同时选取20例因肾功能衰竭患者而行规律血液透析患者作为对照组。 方法：应用荧光实时定量PCR检测121例肾移植患者移植后不同时期血液标本中BK病毒 DNA含量；并根据检测结果进行分为血液BK病毒 DNA均阳性组和血液BK病毒 DNA阴性组。比较两组患者性别、年龄、供肾冷缺血时间，是否发生急性排斥反应、是否发生移植肾功能延迟恢复、免疫抑制剂方案和供肾类型的差异。 主要观察指标：应用logistic多因素分析，确定BK病毒血症发生的危险因素。 结果：肾移植受者BK病毒病毒血症的发生率为24.7%(30/121)，高于肾功能衰竭血透患者其阳性率为5%(1/20)，差异有显著性意义(P=0.03)。多因素分析显示冷缺血时间3.34 (RR 3.34，95% CI 2.76~5.60)和无心跳供肾(RR 2.19，95% CI 1.32~3.97)是移植术后BK病毒血症的危险因素。而移植前年龄、标本留取时间和激素冲击治疗与移植后受者BK病毒血症发生无关。 结论：肾移植后BK病毒感染发生率增高，冷缺血时间延长和无心跳供肾为肾移植后BK病毒感染高危因素。

High risk factors for BK virus viremia in recipients following kidney transplantation

BACKGROUND: One major reason for transplanted kidney failure is BK virus (BKV) associated nephropathy, which leads to renal inadequacy and ureteral obstruction. OBJECTIVE: To identify the incidence of BKV viremia in kidney transplant recipients, as well as to analyze the risk factors of BKV infection. DESIGN, TIME AND SETTING: A retrospective case analysis was performed at the Department of Urology, Affiliated Beijing Friendship Hospital of Capital Medical University from September 2001 to December 2007. PARTICIPANTS: One hundred and twenty-one renal transplant patients, and 20 renal failure patients, who underwent hemodialysis were served as control group. METHODS: The viral load in plasma was quantified with a real-time PCR method. The recipients were divided into the PV+ group (BKV DNA positive blood samples) and PV- group (BKV DNA negative in blood samples) according to the detection outcomes. The gender, age, cold ischemia time, immunosuppressive agent, donor type and other clinical parameters were compared between 2 groups. MAIN OUTCOME MEASURES: Logistic regression was performed to determine risk factors for BKV infection. RESULTS: The incidence rate of BKV viremia accounted for 24.7% (30/121) of kidney recipients, which was higher than the control group (1/20), the difference between them was significant (P = 0.03). Logistic regression found that cold ischemia time (RR 3.34, 95% CI 2.76-5.60) and cadaver donation (RR 2.19, 95% CI 1.32-3.97) were significantly related to BKV viremia. However, ages of recipients, time of collecting samples, and intravenous glucocorticoid therapy was independence to BKV viremia. CONCLUSION: Kidney recipients are the high risk population who are susceptive to BKV infection. Cold ischemia time and cadaver donation may be the risk factors of BKV viremia.