肾移植受体术后早期BK病毒感染的影响因素分析

Influencing factors of early BK virus infection in recipients after kidney transplantation

目的观察肾移植受体术后早期(≤3个月)BK病毒(BK virus,BKV)的感染情况,探讨其术后早期发生BKV感染的影响因素。方法288例肾移植受体术后采用他克莫司+霉酚酸+激素三联免疫抑制方案,根据肾移植术后3个月内是否发生BKV感染分为BKV阴性组175例和BKV阳性组113例,比较2组移植肾功能恢复延迟发生率、供体类型、3个月内急性排斥反应累积发生率等临床资料,比较2组术后1、2、3周与1、2、3个月时他克莫司谷值(tacrolimus trough,TacC_(0))及外周血淋巴细胞计数、前白蛋白和白蛋白水平;采用多因素logistic回归分析肾移植受体术后早期发生BKV感染的危险因素。结果2组移植肾功能恢复延迟、二次移植、3个月内急性排斥反应累积发生率,供体类型及术后1、2、3周与1、2、3个月时外周血白蛋白和前白蛋白水平比较差异均无统计学意义(P>0.05)。BKV阳性组术后1、2、3周及1、2个月时TacC0[(11.4±4.9)、(10.3±2.9)、(9.9±3.0)、(10.2±3.5)、(8.4±2.6)μg/L]均高于BKV阴性组[(10.0±3.3)、(9.5±2.5)、(9.0±2.0)、(9.3±2.2)、(7.7±2.1)μg/L](P<0.05),术后3个月时TacC_(0)[(7.2±1.9)μg/L]与BKV阴性组[(6.9±1.9)μg/L]比较差异无统计学意义(P>0.05)。BKV阳性组术后1、3周时外周血淋巴细胞计数[(0.57±0.33)×10^(9)/L、(1.01±0.51)×10^(9)/L]均低于BKV阴性组[(0.70±0.48)×10^(9)/L、(1.20±0.67)×10^(9)/L](P<0.05),术后2周及1、2、3个月时与BKV阴性组比较差异均无统计学意义(P>0.05)。术后1周TacC_(0)(OR=1.115,95%CI:1.040~1.195,P=0.002)、术后3周TacC_(0)(OR=1.152,95%CI:1.034~1.282,P=0.010)、术后1个月TacC_(0)(OR=1.116,95%CI:1.016~1.225,P=0.022)、术后2个月TacC_(0)(OR=1.135,95%CI:1.016~1.269,P=0.026)、术后1周外周血淋巴细胞计数(OR=0.452,95%CI:0.231~0.887,P=0.021)、术后3周外周血淋巴细胞计数(OR=0.573,95%CI:0.363~0.904,P=0.017)是肾移植受体术后早期发生BKV感染的影响因素。结论肾移植术后1、3周和术后1、2个月时TacC_(0)及术后1、3周时外周血淋巴细胞计数是采用他克莫司免疫抑制方案的肾移植受体术后3个月内发生BKV感染的影响因素。

Objective To observe the early BK virus(BKV)infection in recipients(≤3 months)after kidney transplantation,and to investigate the influencing factors of early BK virus infection.Methods Totally 288 kidney transplantation recipients receiving tacrolimus+mycophenolic acid+corticosteroids therapy after transplantation and were divided into BKV negative group(n=175)and BKV positive group(n=113)according to whether BKV infection occurred within 3 months after kidney transplantation.The incidence of delayed graft function,donor type,cumulative incidence of acute rejection within 3 months,tacrolimus trough(TacC_(0))levels in 1,2 and 3 weeks as well as 1,2 and 3 months after operation,lymphocyte count,prealbumin level and albumin level in peripheral blood were compared between two groups.Multivariate logistic regression analysis was applied to assess the risk factors of early BKV infection in recipients after kidney transplantation.Results There were no significant differences in the incidences of delayed graft function and secondary transplantation,cumulative incidence of acute rejection within 3 months,donor type,and levels of plasma albumin and prealbumin in 1,2and 3weeks as well as 1,2and 3months after operation between two groups(P>0.05).The TacC0levels were higher in BKV positive group in 1week,2weeks,3weeks,1month and 2months after operation[(11.4±4.9),(10.3±2.9),(9.9±3.0),(10.2±3.5),(8.4±2.6)μg/L]than those in BKV negative group[(10.0±3.3),(9.5±2.5),(9.0±2.0),(9.3±2.2),(7.7±2.1)μg/L](P<0.05),and there was no significant difference in TacC0level in 3 months after operation between two groups[(7.2±1.9)μg/L vs.(6.9±1.9)μg/L](P>0.05).The lymphocyte counts were lower in BKV positive group in 1and 3 weeks after operation[(0.57±0.33)×10^(9)/L,(1.01±0.51)×10^(9)/L]than those in BKV negative group[(0.70±0.48)×10^(9)/L,(1.20±0.67)×10^(9)/L](P<0.05),and showed no significant differences in 2weeks,1month,2months and 3months after operation between two groups(P>0.05).The TacC0levels in 1week(OR=1.115,95%CI:1.040-1.195,P=0.002),3weeks(OR=1.152,95%CI:1.034-1.282,P=0.010),1month(OR=1.116,95%CI:1.016-1.225,P=0.022)and 2months(OR=1.135,95%CI:1.016-1.269,P=0.026),as well as the lymphocyte counts in 1week(OR=0.452,95%CI:0.231-0.887,P=0.021)and 3weeks(OR=0.573,95%CI:0.363-0.904,P=0.017)were the influencing factors of early BKV infection in recipients after kidney transplantation.Conclusion In patients receiving tacrolimus based immunosuppressive regimen,the TacC0levels in 1week,3weeks,1month and 2months,as well as the peripheral blood lymphocyte counts in 1and 3 weeks after operation are the influencing factors of BKV infection in recipients within 3months after kidney transplantation.