肾移植术后多瘤病毒感染的临床诊断和治疗

Clinical diagnosis and treatment of BK virus infection in renal transplant recipients

目的 探讨肾移植术后多瘤病毒（BKV）感染的诊断方法、监测指标及初步治疗方法。方法 采集64例肾移植受者的血、尿样本，行BKV细胞学与聚合酶链反应（PCR）检测。对肾移植术后BKV感染的流行病学以及相关因素进行分析，并对BKV感染的受者进行试验性治疗。结果 64例受者的尿Decoy细胞、多瘤病毒尿症与多瘤病毒血症的阳性率分别为28．7％、17．2％和6．3％。血肌酐（Cr）升高的受者尿Decoy细胞阳性率高于血Cr稳定的受者（P=0．04）。受者的性别、年龄、诱导治疗方案、是否发生急性排斥反应以及术后肾功能恢复情况等临床因素与尿Decoy细胞、多瘤病毒尿症及多瘤病毒血症的出现无明显相关性。应用更昔洛韦试验性治疗4例BKV感染的受者，治疗2～3周后，受者的尿Decoy细胞以及血、尿BKV DNA均转为阴性。结论 血肌酐水平升高的肾移植受者易发生BKV再活化。可通过检测血BKV DNA筛查BKV相关的移植肾肾病。更昔洛韦治疗BKV具有良好的疗效，但需进一步验证。

Objective To investigate the prevalence of BK virus （BKV） infection in renal transplant recipients and the methods for its clinical diagnosis and treatment. Methods The urine and blood samples of 64 renal transplant recipients were taken for the BKV cytological and PCR tests. Five clinical factors were investigated to find the etiologic risks of BKV infection in renal transplant recipients. Four BKV infected recipients received experimental treatment. Results The occurrence of urine decoy cell, BKV viruria and viremia in all patients was 28.7%, 17.2% and 6.3%, respectively. The occurrence of urine decoy cell in serum creatinine （SCR） level elevated recipients was higher than that in SCR stable recipients （P = 0.04）. No significant relationships were found between the five clinical factors （gender, age, induction therapy, acute rejection episode, renal function after transplantation） and the occurrence of urine decoy cell, viruria and viremia. Ganciclovir treatment showed effective in four BKV infected recipients. Conclusions BKV monitoring is necessary for those recipients with evaluated SCR levels after renal transplantation. BKV viremia test can be used as a screening test. The efficacy of ganciclovir in the treatment of BKV infection should be further investigated.