尿液BK病毒监测在造血干细胞移植术后出血性膀胱炎中的临床意义  

Clinical significance of monitoring urine BK polyomavirus in patients with hemorrhagic cystitis after hematopoietic stem cell transplantation

作　　者：彭灿辉[1] 伍勇[1] 潘坤 陈辉[1] Peng Canhui;Wu Yong;Pan Kun;Chen Hu(Department of Clinical Laboratory,the Third Xiangya Hospital of Central South University,Changsha 410013,China)

机构地区：[1]中南大学湘稚三医院检验科,长沙市410013 [2]湖南师范大学医学院检验系

出　　处：《中华检验医学杂志》2018年第11期858-862,共5页Chinese Journal of Laboratory Medicine

摘　　要：目的探讨尿液BK病毒（BKV）与造血干细胞移植（HSCT）术后迟发性出血性膀胱炎（HC）的关系。方法回顾性分析2015年6月至2018年4月在中南大学湘雅三医院行HSCT且每周规律进行尿液BKV监测的80例血液病患者，其中女35例，男45例，年龄（20～40）岁，中位年龄30岁，急性髓系白血病（AML）31例，急性淋巴细胞白血病（ALL） 24例，再生障碍性贫血（AA）15例，慢性粒细胞白血病（CML）4例，骨髓增生异常综合征（MDS）等其他疾病6例。分析HSCT后的尿液BKV的阳性率和HC的发生率。根据是否发生HC将尿液BKV阳性的HSCT患者分为HC亚组和非HC亚组。对HC亚组和非HC亚组的尿液BKV载量进行比较和统计学分析。将尿液BKV载量进行对数值转换，符合正态分布的数据以均值±标准差表示，采用t检验、方差分析及ROC曲线等方法进行统计分析，偏态数据以中位数（四分位间距）表示，非正态分布参数比较用Wilcoxon检验。结果80例HSCT患者有43例（53.75%）尿液BKV阳性，其中19例发生HC（23.75%），HC患者均为持续多次尿液BKV阳性患者；37例尿液BKV阴性患者无1例发生HC; HC亚组首次尿液BKV载量、高峰时尿液BKV载量分别为：（7.59±2.46）lg拷贝/ml、（10.56±1.71）lg拷贝/ml，非HC亚组首次尿液BKV载量、高峰时尿液BKV载量分别为（5.75±2.10）lg拷贝/ml、（7.31±2.29）lg拷贝/ml，HC亚组的首次尿液BKV载量、高峰时尿液BKV载量均高于非HC亚组首次尿液BKV载量（t＝2.642，P＝0.012）、高峰时尿液BKV载量（t＝5.147，P＝0.000）。对HC亚组和非HC亚组的首次尿液BKV阳性载量对数值进行ROC曲线分析时，ROC曲线下面积为0.728（95% CI 0.575～0.881），最佳截断点为5.23 lg拷贝/ml（1.68×105拷贝/ml），敏感度为84.20%，特异度为54.17%；对HC亚组和非HC亚组的高峰尿液BKV载量对数值进行ROC曲线分析时，ROC曲线下面积为0.875（95% CI 0.769～0ObjectiveThis study was aimed to analysis the relationship of BK polyomavirus （BKV） and hemorrhagic cystitis （HC） in patients who received hematopoietic stem cell transplantation （HSCT）.MethodsData of 80 patients who received HSCT and took regular urine test every week from June 2015 to April 2018 in the Third Xiangya Hospital of Central South University was retrospectively analyzed, they were 35 females and 45 males （aged 20-40 years, median age 30 years）, and 31 cases with acute myeloid leukemia （AML）, 24 cases with acute lymphoblastic leukemia （ALL）, 15 cases with aplastic anemia （AA）, 4 cases with chronic myeloid leukemia （CML）, 6 cases with other diseases such as myelodysplastic syndrome （MDS） in the study population.The positive rate and incidence of HC were analyzed. Patients who infected with the BK virus were divided into HC group and non-HC group according to occurrence of HC.BK viral load were compared in two groups. Urine BK viral load were analyzed after logarithmic transformation. Data that conforms to a normal distribution is expressed as mean ± standard deviation. t test, ANOVA and ROC curve were used to statistical analysis. Skewed data is expressed in median （interquartile range）, non-normal distribution parameters were compared by Wilcoxon test.ResultsAmong 80 patients, 43 recipients （53.75%） became urinary BK positive, with 19 patients developed HC （23.75%）, all of the 19 HC patients have urinary BK positive, and none of 37 BK-negative patients developed HC; the urine BKV level of the initial time and the peak time in HC group were （7.59±2.46） lg copy/ml, （10.56±1.71） lg copy/ml, the urine BKV level of the initial time and the peak time in non-HC group were （5.75±2.10） lg copy/ml, （7.31±2.29） lg copy /ml. The urine BKV level of the initial time and the peak time in HC group was higher than in non-HC group （t=2.642, P=0.012 and t=5.147, P=0.000 respectively）, when analyzing the urine BKV level of the initial time in HC gro

关 键 词：膀胱炎 造血干细胞移植 BK病毒 病毒载量 尿分析 

分 类 号：R446.12[医药卫生—诊断学]