抢救性治疗对肾移植后BK病毒感染及其相关性肾病的临床效果  

Clinical observation of BK viremia and BK virus-associated nephropathy with rescuing therapy in renal-transplant recipients

作　　者：解俊杰 石炳毅 范宇 柏宏伟 李钢 王洪阳 钱叶勇 

机构地区：[1]解放军第三〇九医院器官移植研究所泌尿二科,北京100091

出　　处：《中华器官移植杂志》2013年第2期105-109,共5页Chinese Journal of Organ Transplantation

摘　　要：目的探讨抢救性治疗对肾移植术后BK病毒（BKV）感染及BKV相关性肾病（BKVAN）的临床疗效。方法选取2010年至2011年间接受。肾移植手术的116例受者，分别在术后第0．5、1、3、6、9、12和15个月等时间点定期收集尿和血清样本，采用实时荧光定量聚合酶链反应技术检测尿和血清中的BKVDNA载量，观察受者的BKV感染情况，并对具备指征的受者行移植肾活检，对发生BKV感染及BKVAN的受者进行抢救性治疗。结果116例受者中，有52例BKV尿症阳性，发生率为44．8％，尿BKV DNA载量为2．63×10^5拷贝／ml（1．78×10^3～8．54×10^9拷贝／m1）；24例BKV血症阳性，发生率为20．7％，血清BKVDNA载量为2．70×10^4拷贝／ml（1．95×10^3～6．31×10^6拷贝／ml）；4例受者经病理活检证实发生BKVAN，发生率为3．4％。BKV感染及BKVAN发生的高峰时间中位数为术后3个月，高峰时间段均为术后3～9个月。经减少免疫抑制剂用量或转换免疫抑制剂方案等抢救性治疗后，发生BKV血症及BKVAN的受者，病情得到有效好转，血清BKVDNA转为阴性，尿BKVDNA载量明显下降。治疗过程中无一例受者发生急性排斥反应或移植肾功能丧失。结论对于明确诊断为BKV血症及BKVAN的受者，及时减少免疫抑制剂用量或转换免疫抑制方案是一种有效的治疗策略，且不会增加急性排斥反应和移植肾功能丧失的风险，但治疗期间需密切监测急性排斥反应。Objective To investigate the clinical efficacy of BK viremia and BK virus-associated nephropathy （BKVAN） with rescuing therapy in renal-transplant recipients. Methods We systematically screened for active BKV infection at 0. 5, 1, 3, 6, 9, 12 and 15 months after transplantation in 116 renal transplant recipients. The screening tests included BKV DNA PCR （the kit for testing the BK virus） assay of both urine and plasma, and the results were recorded. Renal biopsy was performed if the graft function deteriorated gradually or the loads of BKV replication were very high. According to the existing literature material, preferential therapy was given to the patients with BK viremia and BKVAN after renal transplantation. Results Throughout the follow-up of 15 months, urine BKV viruria （median 2. 63 ×10^5copies/mL, 1.78× 10^3-8. 54× 10^9copies/mL）, blood BKV viremia （median 2. 70 × 10^4 copies/mL, 1.95 × 10^3-6. 31 × 10^6 copies/mL）, and BKVAN （4 patients） occurred in 24.17%, 20.72% and 3.45% renal-transplant recipients, respectively. According to related literature and guide, in 24 cases of BKV viremia including 4 BKVAN patients, the dosages of immunosuppressants were reduced or FK506 was replaced with CsA, the disease conditions were effectively improved, and no acute rejection, allograft dysfunction or graft loss occurred. Conclusion Rescuing therapy of immunosuppression reduction or replacing FK506 with CsA was effective for BKV viremia and BKVAN recipients, and could not increase the risk of acute rejection and graft loss.

关 键 词：造血干细胞移植 白血病 复发 供者 CIK细胞 

分 类 号：R699[医药卫生—泌尿科学]