肾移植术后BK病毒感染及危险因素分析

Risk factor analysis of BK virus infection in renal transplant recipients

目的目前国内关注肾移植术后BK病毒感染的研究较少。文中旨在研究国内肾移植术后BK病毒感染情况,分析肾移植术后BK病毒感染的危险因素。方法回顾性分析2015年6月至2016年7月于南京军区南京总医院肾脏科常规接受血、尿液BK病毒DNA检测的肾移植术后患者448例,并同时期纳入尿毒症透析患者167例、健康活体供者71例。根据血、尿液中BK病毒DNA的检测结果,将肾移植术后患者分为2组:BK病毒DNA阳性组(n=89,尿液或血及尿液BK病毒DNA同时阳性)、BK病毒DNA阴性组(n=359,血及尿液BK病毒DNA均阴性)。分析肾移植术后BK病毒感染情况,探讨肾移植患者的一般情况、术后并发症及免疫抑制剂方案等因素对BK病毒感染是否有影响。结果肾移植术后患者的尿液BK病毒DNA阳性率(19.9%)较尿毒症透析患者(6.3%)、健康活体供者(4.2%)升高(P<0.001)。多因素logistic回归分析显示术后肺部感染(OR=3.468,95%CI:1.227~9.802)、急性排斥反应(OR=2.645,95%CI:1.142~6.127)、服用FK506(OR=2.408,95%CI:1.104~5.254)与BK病毒感染相关。结论肾移植术后要格外注意BK病毒的感染的发生率明显增加。术后肺部感染、急性排斥反应及应用以FK506为主的免疫抑制剂方案均可增加肾移植术后BK病毒感染的风险。

Objective Little research has been done on the risk factor analysis of BK virus（ BKV） infection in renal transplant recipients in Chinese population. The article aimed to investigate BKV infection and analyze its risk factors in renal transplant recipients in China. Methods Renal transplant recipients who had received the detection of BKV DNA in urine and blood samples in Nanjing General Hospital from June 2015 to July 2016 were selected,while the patients with uremia hemodialysis and healthy living donors were included as control group. According to the detection results of BKV DNA in urine and blood samples,renal transplant recipients were divided into BKV DNA positive group（ n = 89,positive urine or blood and urine BKV DNA） and BKV DNA negative group（ n= 359,negative blood and urine BKV DNA）. Analysis was made on BKV infection in renal transplant recipients in order to investigate the effects of factors including clinical condition,postoperative complications and immunosuppressive regimen on BKV infection.Results The positive rate of BKV DNA in urine samples of renal transplant recipients was 19.9%,which was higher than those of patients with dialysis and healthy living donors（ 6. 3% and 4. 2%respectively,P 〈 0.001）. Multivariate logistic regression analysis showed BKV infection was associated with pulmonary infection（ OR[95%CI],3.468[1.227-9.802]; P= 0.019）,acute rejection（ OR[95%CI],2.645[1. 142-6. 127]; P = 0. 023）,and FK506（ OR[95%CI],2.408[1.104-5.254]; P = 0.027）. Conclusion The incidence of BKV infection in renal transplant recipients increases significantly. Pulmonary infection,acute rejection and FK506-based immunosuppressive regimen are risk factors leading to BKV infection.