肾移植早期25-羟基维生素D水平对BK病毒感染风险的影响

Effect of 25-hydroxyvitamin D level on the risk of BK virus infection in early stage after renal transplantation

目的探讨肾移植早期25-羟基维生素D[25(OH)D]水平对BK病毒(BKV)感染风险的影响,为肾移植术后BKV感染风险评估、早期预测及诊断和预防提供参考依据。方法选取2017年1月至2022年3月该院肾移植受者573例,随访移植术后1年内BKV感染情况,按照相关文献获得肾移植早期25(OH)D缺乏或不足的发生率;分析肾移植术后早期25(OH)D缺乏或不足与BKV感染的相关性及对其风险的影响,以及肾移植术后早期25(OH)D水平对BKV感染的早期预测及诊断价值。结果(1)该研究BKV感染发生率为56.9%(326例),其中BKV尿症为56.7%(325例)、BKV血症为7.90%(45例)、BK病毒相关性肾病(BKVAN)为0.35%(2例)。(2)25(OH)D缺乏或不足发生率为71.8%(411例),其中25(OH)D缺乏组占比为37.2%(213例),不足组占比为34.6%(198例)。(3)BKV未感染、BKV尿症、BKV血症中,25(OH)D缺乏和不足发生率依次逐渐增高,25(OH)D正常率逐渐减低,差异有统计学意义(P<0.05)。(4)多因素Logistic回归分析显示,男性、25(OH)D缺乏或不足是BKV感染的独立危险因素(P<0.05)。(5)受试者工作特征(ROC)曲线分析表明,肾移植早期25(OH)D水平预测及诊断术后BKV感染的曲线下面积(AUC)为0.781(95%CI:0.742~0.819),截断值为15.45 ng/mL,联合性别后AUC为0.818(95%CI:0.772~0.844)。结论该院肾移植术后1年内BKV感染发生率较高,移植早期25(OH)D缺乏或不足普遍存在,是BKV感染的独立危险因素,且25(OH)D水平对BKV感染有一定早期预测、诊断价值。临床应重视肾移植早期25(OH)D水平的监测与补充,从而有效降低BKV感染风险。

Objective To investigate the effect of 25-hydroxyvitamin D[25(OH)D]level on the risk of BK virus(BKV)infection in the early stage after renal transplantation,and to provide reference for the risk assessment,early prediction,diagnosis and prevention of BKV infection after renal transplantation.Methods A total of 573 renal transplant recipients in the Second People′s Hospital of Shanxi Province from January 2017 to March 2022 were selected.The BKV infection within 1 year after transplantation was followed up.According to the related literature,the incidence of 25(OH)D deficiency or insufficiency in renal transplant recipients was obtained.The correlation between 25(OH)D deficiency or insufficiency and BKV infection in the early stage after renal transplantation as well as its impact on the risk were analyzed.The early predictive and diagnostic value of 25(OH)D level for the BKV infection after renal transplantation was analyzed.Results Firstly,the incidence of BKV infection in this study was 56.9%(326 cases),including 56.7%(325 cases)of BKV hematuria,7.90%(45 cases)of BKV viremia and 0.35%(2 cases)of BKV associated nephropathy(BKVAN).Secondly,the incidence of 25(OH)D deficiency or insufficiency was 71.8%(411 cases),of which 25(OH)D deficiency group accounted for 37.2%(213 cases)and insufficiency group accounted for 34.6%(198 cases).Thirdly,the incidence of 25(OH)D deficiency and insufficiency in patients with BK non-infection,BKV urine disease and BKV blood disease increased significantly in turn,and the normal rate of 25(OH)D gradually decreased,and the differences were statistically significant(P<0.05).Fourthly,multivariate Logistic regression analysis showed that male,25(OH)D deficiency or insufficiency were independent risk factors for BKV infection(P<0.05).Lastly,receiver operating characteristic(ROC)curve analysis showed that the area under the curve(AUC)of 25(OH)D level in predicting and diagnosing BKV infection after renal transplantation was 0.781(95%CI:0.742-0.819),and the cut-off value was 15.45 ng/mL.The AUC was 0.818(95%CI:0.772-0.844)after combining gender.Conclusion The incidence of BKV infection is high within 1 year after renal transplantation in the hospital.The deficiency or insufficiency of 25(OH)D is common in the early stage after transplantation,and it is an independent risk factor for BKV infection.The level of 25(OH)D has certain early predictive and diagnostic value for BKV infection.Clinical attention should be paid to the monitoring and supplementation of 25(OH)D levels in the early stage after renal transplantation,so as to effectively reduce the risk of BKV infection.