肾移植受者BK病毒血症危险因素荟萃分析  

Risk factors for BK viremia in kidney transplantation recipients: A meta-analysis

作　　者：刘炎忠 钱叶勇[1,2] 石炳毅[2] 王振[2] 柏宏伟[2] 范宇[1,2] 

机构地区：[1]解放军医学院,北京100853 [2]解放军第309医院,北京100091

出　　处：《解放军医学院学报》2014年第2期112-115,共4页Academic Journal of Chinese PLA Medical School

基　　金：首都临床特色应用研究(Z13110700220000)~~

摘　　要：目的 应用荟萃分析系统评价肾移植受者发生BK 病毒血症（BKV viremia） 的相关危险因素。 方法 系统检索中国期刊全文数据库、中国生物医学数据库、PubMed 数据库、西文生物医学数据库2000 年1 月- 2013 年8 月公开发表的关于肾移植受者BK 病毒血症相关危险因素的研究论文，并查阅各个研究中引用的参考文献来补充。观察性研究（ 队列研究和病例对照研究） 参照文献关于观察性研究方法学质量评估的建议进行评价；随机对照研究利用Jadad 量表进行评价。应用Stata11.0 软件进行一致性检验，使用固定效应模型及随机效应模型进行合并，计算相对危险度（relative risk，RR） 及其95% CI。 结果 纳入16 篇文献，共计925 例肾移植术后BK 病毒血症患者。BK 病毒血症发生的危险因素为高龄[1.032（1.017 -1.047），P =0.000]、冷缺血时间长[1.737（1.191 - 2.535），P =0.004]、人类白细胞抗原（human leukocyte antigen，HLA） 错配数4个及以上[1.303（1.103 - 1.540），P =0.002]、使用抗胸腺细胞球蛋白免疫诱导[1.230（1.041 - 1.453），P =0.015]、急性排斥反应[3.672（2.106 - 6.402），P =0.000]、移植肾功能恢复延迟[1.57（1.08 - 2.29），P =0.018]、使用FK506＋MMF 免疫维持[1.632（1.329 - 2.005），P =0.000]、巨细胞病毒感染[2.182（1.286 - 3.700），P =0.004]。多种相关危险因素并存时BK 病毒血症的风险大于单一因素。 结论 高龄、冷缺血时间长等均是肾移植受者BK 病毒血症发生的危险因素。Objective To assess the risk factors for BKV viremia in kidney transplantation recipients by meta-analysis. Methods Papers and their references on the risk factors for BKV viremia in kidney transplantation recipients published from January 2000 to August 2013 were retrieved from CAJD, CBM, PubMed and Foreign Medical Journal Full-Text Database. Cohort and case control studies were assessed according to the quality assessment methodology suggested in the references. Randomized control trials （RCT） were assessed following the Jadad scale. Heterogeneity of RCT was tested using Software Stata 11.0. The risk ratio （RR） and its 95%CI were calculated according to the fixed or random effect model. Results Sixteen papers （925 cases of BKV viremia following kidney transplantation） were included in the meta-analysis. Advanced age [1.032（1.017-1.047）, P=0.000], long cold ischemia[1.737（1.191- 2.535）, P=0.004], ≥ 4 mismatched HLA[1.303（1.103-1.540）, P=0.002], immune induction using ATG[1.230 （1.041-1.453）, P=0.015], DGF[1.57（1.08-2.29）, P =0.018], acute rejection [3.672（2.106-6.402）, P =0.000], immune maintenance therapy with FK506＋MMF[1.632（1.329-2.005）, P=0.000], and CMV infection[2.182（1.286-3.700）, P=0.004] were the risk factors for BK viremia. The risk was greater to develop BK viremia in patients with multiple risk factors than in those with a single risk factor. Conclusion Advanced age, long cold ischemia, ≥ 4 mismatched HLA, immune induction using ATG, DGF, acute rejection, immune maintenance therapy with FK506＋MMF, and CMV infection are the risk factors for BK viremia in kidney transplantation recipients.

关 键 词：肾移植 BK病毒 危险因素 META分析 

分 类 号：R692.5[医药卫生—泌尿科学]