单中心101例多瘤病毒肾病的临床病理特点

Clinicopathologic characteristics of polyomavirus nephropathy in renal transplantation： 101 cases of experience in single center

目的总结肾移植术后多瘤病毒肾病（PyVN）的临床病理特点及预后。方法回顾性分析2006年1月至2016年10月本中心101例PyVN患者的临床资料，以及病毒学和病理学检测结果。男72例，女29例。101例确诊PyVN时距离手术时间为16.5个月（2.2～63.9个月），其中术后2年内86例（85.1%）。移植肾穿刺原因包括血肌酐较基础值升高81例（80.2%），血肌酐升高伴蛋白尿13例（12.9%），筛查发现BK病毒感染5例（5.0%），单纯蛋白尿2例（2.0%）。结果101例确诊PyVN时，98例（97.0%）尿BK病毒-DNA阳性，病毒载量为1.5×10^9拷贝/ml（0～9.0×10^11拷贝/ml），80例（79.2%）血BK病毒-DNA阳性，病毒载量为1.8×10^4拷贝/ml（0～2.1×10^7拷贝/ml）。确诊时5例患者移植肾失功，96例带功患者的中位血肌酐为187.0 μmol/L。中位随访20.1个月（3.7～109.6个月），新增失功患者19例（18.8%）。其余77例带功患者的中位血肌酐为165.0 μmol/L，与确诊时带功患者血肌酐相比差异无统计学意义（P〉0.05）。101例PyVN患者中A期18例，B期72例，C期11例。用Kaplan-Meier法计算A期、B期和C期患者术后5年移植肾存活率分别为92.9%、82.8%和55.6%。结论PyVN可发生在肾移植术后5年内，尤其以术后2年内多见，临床表现以血肌酐升高、BKV血症和BKV尿症为主。移植肾组织病理损伤程度越重，临床预后越差。

ObjectiveTo explore the clinicopathologic characteristics of polyomavirus nephropathy （PyVN） in renal transplantation.MethodsClinicopathological data from 101 cases of PyVN from January 2006 to October 2016 in our hospital were collected and analyzed retrospectively. There were 72 males and 29 females. The mean time from operation to the diagnosis of PyVN was 16.5 months （2.2-63.9 months）, with 86 cases （85.1%） occurring within 2 years. The indications for biopsy included elevated serum creatinine in 81 cases （80.2%）, elevated serum creatinine with proteinuria in 13 （12.9%） cases, active BK virus（BKV） infection in 5 cases （5.0%） and proteinuria in 2 cases （2.0%）.ResultsBK viruia was detected in 98 （97.0%） recipients with viral loads of 1.5×10^9 （0-9.0×10^11） copies/ml, and BK viremia in 80 （79.2%） recipients with viral loads of 1.8×10^4（0-2.1×10^7） copies/ml. 5 patients lost their graft function at biopsy and the other 96 patients reserved graft function with serum creatinine of 187.0 μmol/L. After 20.1 （3.7-109.6） months of follow-up, 19 （18.8%） patients lost their graft function. The average serum creatinine of the 77 patients with graft function was 165.0 μmol/L, with no statistical difference （P〉0.05） compared with that of patients at diagnosis. There were 18 cases of stage A, 72 cases of stage B and 11 cases of stage C with 5-year allograft cumulative survival of 92.9%, 82.8% and 55.6%, respectively.ConclusionsPyVN can occur within 5 years after renal transplantation, mostly within 2 years. The typical clinical manifestations include elevated serum creatinine, BK viruia and BK viremia. The severe the histopathological lesions were correlated the worse the clinical prognosis.