血、尿BK病毒DNA检测对BK病毒相关性肾病的诊断价值

Diagnostic value of serum and urine BKV-DNA for BKV nephropathy

目的研究血液、尿液中人多瘤病毒(BKV)对BK病毒相关性肾病(BKVN)的诊断价值。方法选取中山大学附属第一医院肾移植术后的病人97例,根据是否发生BKNV分为BKVN组(n=61)和非BKVN组(n=36),用PCR检测病人血液、尿液中BKV DNA的拷贝数,绘制ROC曲线评价血液、尿液BKV DNA对BKVN的诊断价值。结果 BKVN组中,血液的[(2.7×10^(5)±1.1×10^(5))copies/mL vs.(3.0×10^(2)±1.3×10^(2))copies/mL]、尿液的[(4.8×10^(8)±2.0×10^(8))copies/mL vs.(2.1×10^(6)±0.9×10^(5))copies/mL]BKV DNA复制水平均显著高于非BKVN组(P<0.05)。尿液BKV的ROC曲线下面积为0.752(95%CI:0.652~0.852,P<0.001),最佳阈值为8.2×10^(7)copies/mL,敏感度为76.1%,特异度为75.0%;血液BKV的ROC曲线下面积为0.736(95%CI:0.637~0.836,P<0.001),最佳阈值为1.6×10^(5)copies/mL,敏感度为66.0%,特异度为97.2%。联合血液和尿液BKV的ROC曲线下面积为0.791(95%CI:0.700~0.882,P<0.001)。结论血液和尿液的BKV DNA检测具有诊断BKVN的价值,尿液的敏感性较高,血液的特异性更好,联合检测拥有更高的诊断价值。

Objective To explore the diagnostic value of BKV-DNA in serum and urine for BKV nephropathy(BKVN).Methods A total of 97 patients after renal transplantation in our hospital were retrospectively analyzed.These patients were divided into BKVN group(n=61) and non-BKVN group(n=36) according to whether BKNV occurred.The BKV-DNA loads were measured by PCR,and the diagnostic value of BKV-DNA for BKVN was evaluated by receiver operating characteristic curve(ROC curves).Results In the BKVN group,the levels of BKV-DNA replication in serum [(2.7×10^(5)±1.1×10^(5))copies/mL vs.(3.0×10^(2)±1.3×10^(2)) copies/mL] and urine [(4.8 ×10^(8)±2.0×10^(8)) copies/mL vs.(2.1 ×10^(6)±0.9×10^(5))] copies/mL were significantly higher than those in the non-BKVN group,and the difference was statistically significant(all P<0.05).The best cutoff of BKV-DNA in urine for prediction of BKVN was 8.2×10^(7) copies/mL with a sensitivity of 76.1% and a specificity of 75.0%(AUC:0.752,95%CI:0.652-0.852,P<0.001).The best cutoff of BKV-DNA in serum for prediction of BKVN was 1.6×10^(5) copies/mL with a sensitivity of 66.0% and a specificity of 97.2%(AUC:0.736,95%CI:0.637-0.836,P<0.001).The AUC area of combined serum and urine BKV-DNA was 0.791(95% CI:0.700-0.882,P<0.001).Conclusions The BKV DNA test of blood and urine had the value of diagnosing BKVN.The sensitivity of urine was higher,the specificity of blood was better,and the combined test had higher diagnostic value.