FK506、肾功能指标及单个核细胞计数判断肾移植患者尿BKV DNA阳性的价值

Roles of FK506,renal function indexes and mononuclear cell count in the judgment of renal transplant recipients with positive urinary BKV DNA

目的探讨血FK506、尿素、肌酐(Cr)及单个核细胞计数判断肾移植患者尿BK病毒(BKV)DNA阳性的价值。方法检测197例肾移植患者尿BKV DNA及血FK506、尿素、Cr、淋巴细胞百分比(LYMPH%)、淋巴细胞绝对值(LYMPH#)、单核细胞百分比(MO%)、单核细胞绝对值(MO#)。以尿BKV DNA≥2.0×10^(3)拷贝/mL为BKV阳性组,<2.0×10^(3)拷贝/mL为BKV阴性组。另选取21例术后3~6个月内多次检测尿BKV DNA,并首次出现阴性转阳性的患者进行配对比较。采用受试者工作特征(ROC)曲线评价各项指标判断尿BKV DNA阳性的效能。采用Pearson相关分析或Spearman相关分析评估各项指标与尿BKV DNA载量的相关性。对比21例患者首次出现尿BKV DNA由阴性转阳性时各项指标的变化。结果BKV阳性组FK506、尿素、Cr水平高于BKV阴性组(P<0.05),2个组之间LYMPH%、LYMPH#、MO%、MO#差异均无统计学意义(P>0.05)。相关性分析结果显示,尿BKV DNA载量与血FK506水平呈正相关(r=0.466,P<0.001),与尿素、Cr无相关性(r值分别为0.157、0.156,P>0.05)。ROC曲线分析显示,FK506、尿素和Cr判断尿BKV DNA阳性的曲线下面积(AUC)分别为0.685、0.581、0.606,最佳临界值分别为7.05 ng/mL、7.20 mmol/L、100.5μmol/L,敏感性分别为58.3%、71.4%、83.3%,特异性分别为74.3%、46.0%、38.1%。与尿BKV DNA阴性时比较,同一患者首次出现尿BKV DNA阳性时的FK506水平明显升高(P<0.001),尿素及Cr水平差异无统计学意义(P>0.05)。结论血FK506对判断肾移植术后患者尿BKV DNA阳性有一定价值。

Objective To investigate the roles of FK506,urea,creatinine(Cr)and mononuclear cell count in the judgment of renal transplant recipients with positive urinary BK virus(BKV)DNA.Methods Urinary BKV DNA were determined in 197 renal transplant recipients,which the cases≥2.0×10^(3) copies/mL were enrolled in positive group,and which the cases<2.0×10^(3) copies/mL were enrolled in negative group.The differences of FK506,urea,Cr,the percentage of lymphocyte(LYMPH%)and the absolute value of lymphocyte(LYMPH#),the percentage of monocyte(MO%)and the absolute value of monocyte(MO#)between the 2 groups were evaluated.A total of 21 patients with negative to positive urinary BKV DNA within 3 to 6 months after transplantation were enrolled for matching comparison.The efficiency of determining positive urinary BKV DNA by each indicator was evaluated by receiver operating characteristic(ROC)curve,and the correlation between each indicator and urinary BKV DNA load was evaluated by Pearson or Spearman analysis.The indicators with significant difference were compared in 21 recipients with the first change of urinary BKV DNA from negative to positive.Results The levels of FK506,urea and Cr in BKV positive group were higher than those in BKV negative group(P<0.05).LYMPH%,LYMPH#,MO%and MO#showed no statistical significance between the 2 groups(P>0.05).Urinary BKV DNA load was positively correlated with FK506(r=0.466,P<0.001),and there was no correlation with urea(r=0.157)and Cr(r=0.156)(P>0.05).ROC curve analysis showed that the areas under curves(AUC)of FK506,urea and Cr for the positive determination of urinary BKV DNA were 0.685,0.581 and 0.606,respectively.The optimal cut-off values were 7.05 ng/mL,7.20 mmol/L and 100.5μmol/L,respectively.The sensitivities were 58.3%,71.4%and 83.3%,and the specificities were 74.3%,46.0%and 38.1%,respectively.FK506 was increased in the 21 recipients when they firstly experienced urinary BKV DNA conversion from negative to positive(P<0.001),and urea and Cr had no statistical significance(P>0.05).Conclusions FK506 is valuable in the judgment of renal transplant recipients with positive urinary BKV DNA.