肾移植受者BK病毒相关性肾病的危险因素分析

Analysis on BK virus associated nephropathy related risk factors in renal transplant recipients

目的 探讨影响肾移植受者BK病毒相关性肾病（BKVAN）的危险因素.方法 选取2006年1月至2014年12月于中山大学附属第一医院行移植肾穿刺活检的615例肾移植受者,肾穿刺同时收集血、尿标本,进行尿沉渣Decoy细胞计数,尿、血标本中BK病毒（BKV）DNA含量的检测.并且运用普通病理染色、免疫组织化学染色的方法检查移植肾组织确定BKVAN的诊断并进行病理分期.应用Logistic回归法分析筛选BKVAN的危险因素.结果 615例肾移植受者尿液Decoy细胞、尿BKV DNA及血BKV DNA的阳性率分别为13.7％（84/615）、29.3％（180/615）和8.8％（54/615）.病理确诊BKVAN49例.BKVAN患者尿沉渣Decoy细胞阳性率、尿、血标本中BK病毒DNA阳性率及含量均高于无BKVAN患者（P＜0.05）.他克莫司（Tac）联合霉酚酸（MPA）维持治疗方案（OR=12.4,P=0.001）和移植后重症肺炎（OR =3.7,P=0.001）是影响肾移植受者BKVAN发生的独立危险因素.结论 使用Tac＋ MPA的用药组合,并且检测到BKV复制明显的肾移植受者,诊断上应高度警惕BKVAN.

Objective To analyze the risk factors affecting BK virus associated nephropathy （BKVAN） after kidney transplantation.Methods Three screening methods for BKVAN including quantitative PCR assay for BK virus（BKV） DNA load in urine and plasma and quantitative assay of urine cytology concurrently with renal transplant biopsies for the evaluation of 615 patients from January 2006 to December 2014 were used.The renal allograft biopsy specimens were analyzed by routine histologic examination,immunohistochemistry and classified into three categories of BKVAN.Potential variables were analyzed by Logistic regression model multivariate analysis to assess and rank BKVAN related risk factors.Results The positive rate of urine decoy cell,BKV viruria and viremia in 615 renal recipients were 13.7% （84/615）,29.3% （180/615）,and 8.8% （54/615）,respectively.BKVAN were diagnosed in 49 recipients.The incidence and the median level of the number of the decoy cell,BK viral load in urine and plasma were higher in the BKVAN group than those in non-BKVAN group （all P 〈 0.05）.Tacrolimus （Tac） combined with mycopbenolic acid （MPA） protocol （OR =12.4,P =0.001） and severe pneumonia post-transplant （OR =3.7,P =0.001） were the independent risk factors impacting on BKVAN in renal recipients.Conclusions The renal recipients with high level of BKV replication,whose immunosuppressant protocol include Tac and MPA,should be suspected the diagnosis of BKVAN.