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| 肾移植患者术后BK病毒感染的检测及危险因素分析 |
| 陆明,朱有华,王皓,韩澍,冀俊峰 |
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| (南通市第一人民医院泌尿外科,南通,226001;第二军医大学长征医院器官移植科,解放军器官移植研究所,上海,200003;长征医院实验诊断科,解放军临床免疫中心) |
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| 摘要: |
| 目的:检测肾移植患者术后BK病毒(BKV)感染率,分析BKV感染的危险因素.方法:收集63例肾移植患者术后第1、 2、3、4、6 和8个月的尿液和血液标本,实时荧光定量PCR方法检测标本中BKV DNA含量,并根据检测结果进行分组:尿液、血液BKV DNA均阳性者为UV+PV+组,尿液阳性而血液阴性者为UV+PV-组,尿液、血液均阴性者为UV-PV-组.尿沉渣涂片寻找含有病毒包涵体的脱落尿路上皮细胞(Decoy细胞),并对Decoy细胞进行细胞免疫学检测;对临床高度怀疑为BK病毒相关性肾病患者(BKVAN)行移植肾活检.比较3组患者的年龄、术前冷缺血时间、术前血透时间、免疫抑制方案、群体反应性抗体(PRA)致敏程度、术后是否合并其他病毒感染等临床指标的差异,应用Logistic回归法分析筛选BKV感染和BKVAN发生的危险因素.结果:UV+PV-组19例(30.1﹪), UV+PV+组患者9例(14.3﹪),UV-PV-组患者35例;前两组首次发现BKV的中位时间分别为术后4个月和3个月.63例患者Decoy细胞检出率为39.7﹪,Decoy细胞免疫染色阳性率为54.3﹪.1例移植肾活检未见BKVAN表现.Logistic回归法发现BKV DNA感染与冷缺血时间有显著联系(P=0.048;OR=1.151),与其他指标无显著相关(P=0.069).结论:实时荧光定量PCR能较好地监测术后BKV感染,术后3～4个月是BKV排泄高峰,术前冷缺血时间可能是BKV感染的危险因素之一,而术后免疫抑制方案对BKV感染可能无明显影响. |
| 关键词: BK病毒、肾移植、Decoy细胞 |
| DOI：10.3724/SP.J.1008.2007.00071 |
| 投稿时间：2006-05-23修订日期：2006-11-27 |
| 基金项目: |
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| BK virus infection in renal transplant recipients: diagnosis and risk factors analysis |
| LU Ming,ZHU You-hua,WANG Hao,HAN Shu,JI Jun-feng |
| (南通市第一人民医院泌尿外科,南通,226001;第二军医大学长征医院器官移植科,解放军器官移植研究所,上海,200003) |
| Abstract: |
| Objective：To investigate the incidence of BK virus infection in renal transplant recipients and to analyze the risk factors of BKV infection. Methods： The urine samples and peripheral blood samples of 63 renal transplant recipients were collected at 1, 2, 3, 4, 6 and 8 months after transplantation. A real-time fluorescent PCR procedure was used to detect BK virus DNA in the samples and the samples were divided into the following 3 groups according to the detection outcomes： UV^＋PV^＋ group （BKV DNA positive in both urine and blood samples）, UV^-PV^- group （BKV DNA positive in urine but negative in blood samples）, and UV^-PV^- group （BKV DNA negative in both urine and blood samples）. Urinary sediment smears of patients were checked for decoy cells and the decoy cells were subjected to cytological immunostaining. Renal graft biopsy was performed when a sample was highly suspected of BKVAN by its clinical manifestations. The age, cold ischemia time, hematodialysis duration, immunosuppressive agents, panel reactive antibody, and other clinical parameters were compared between the 3 groups and a Logistic regression was performed to analyze the risk factors of BK virus infection. Results： There were 19 （30.1 %） patients in UV^＋PV^- group, 9 （14.3%）in UV^＋PV^＋ group, and 35 in UV^-PV^- group. The median time for the first detection of BK virus was 4 months in UV^＋ PV^- group and 3 months in UV^＋ PV^＋ group. Decoy cells were detected in 39. 7% of the 63 patients and the positive rate of decoy cell immunostaining was 54. 3%. One patient showed no BDVAN manifestation in renal biopsy. Logistic regression found that the cold ischemia time was significantly related to the BKV DNA infection （P= 0. 048, OR = 1. 151 ）, but not to other parameters （ P = 0. 069 ）. Conclusion ： Real-time fluorescent quantitative PCR is a good way for detection of BKV infection after renal transplantation. The peak time for BKV shedding is 3-4 months after transplantation. Cold ischemia time may be one of the risk factors of BKV infection, and immunosupressive regiment may has no obvious influence on BK virus infection |
| Key words: BK virus renal transplantation, Decoy cell |
