3例肾移植术后BK病毒感染合并移植肾急性T细胞排斥反应的治疗方案  

Treatment of acute T cell rejection of transplanted kidney in 3 patients with BK virus infection

作　　者：王凯[1] 李明[1] 乔良伟 曲青山[1] 苗书斋[1] 蒋欣[1] WANG Kai;LI Ming;QIAO Liangwei;QU Qingshan;MIAO Shuzhai;JIANG Xin(Department of Organ Transplantation,Zhengzhou People\s Hospital,Zhengzhou 450003,China)

机构地区：[1]郑州人民医院器官移植科,郑州450003

出　　处：《中华实用诊断与治疗杂志》2020年第11期1119-1121,共3页Journal of Chinese Practical Diagnosis and Therapy

基　　金：河南省医学科技攻关计划项目(2018020823)。

摘　　要：目的探讨肾移植术后BK病毒感染合并移植肾轻度急性T细胞排斥反应的有效治疗方案。方法行肾移植术患者3例,术后第1天给予他克莫司+吗替麦考酚酯+醋酸泼尼松预防排斥反应,术后11~18个月均出现肾功能异常,经组织病理学检查和免疫组织化学检查诊断为BK病毒感染合并移植肾轻度急性T细胞介导的排斥反应。调整免疫抑制剂治疗方案为口服环孢素胶囊100mg/次,2次/d;西罗莫司胶囊0.5mg/次,1次/d;来氟米特片20mg/次,2次/d;醋酸泼尼松片10mg/次,1次/d。定期监测肾功能、环孢素和西罗莫司浓度及BK病毒复制情况。结果治疗1~4周,3例患者环孢素浓度维持在100μg/L,西罗莫司浓度维持在3~5μg/L;3例患者肾功能均好转,例1和例2血肌酐(135、130μmol/L)均较治疗前(166、152μmol/L)明显下降,例3血肌酐(146μmol/L)较治疗前(155μmol/L)下降不明显。调整免疫抑制剂治疗方案2个月,3例患者尿BK病毒定量[例1、例2、例3分别为(5.52×10^4)、(4.79×10^4)、(2.58×10^5)copies/mL]均较治疗前[(9.89×10^9)、(5.75×10^7)、(3.71×10^8)copies/mL]明显下降,血BK病毒定量均转阴,病毒治疗效果较满意。结论肾移植术后出现BK病毒感染合并移植肾急性排斥反应时,首先需处理对移植肾功能和预后影响较大的急性排斥反应,同时兼顾BK病毒的治疗。Objective To investigate the effective treatment of mild acute T cell rejection of transplanted kidney after kidney transplantation in 3patients with BK virus(BKV)infection.Methods Three patients after kidney transplantation were given tacrolimus+mycophenolate mofetil+prednisone on the 1st postoperative day to prevent rejection,and abnormal renal function occurred in all patients in 11 to 18 months after operation.Histopathological and immunohistochemical examinations were performed and confirmed BKV infection combined with mild acute T cell-mediated rejection of transplanted kidney.The immunosuppressive regimens were adjusted as cyclosporin capsules 100mg twice a day,sirolimus capsules 0.5mg once a day,Leflunomide tablets 20mg twice a day,and prednisolone tablets 10 mg once a day.The renal function,cyclosporin and sirolimus concentrations and BKV replication were monitored regularly.Results After 1to 4weeks of treatment,the concentrations of cyclosporin and sirolimus maintained at 100μg/L and 3to 5μg/L in 3patients.The renal function of these 3patients was improved.The serum creatinine level decreased from 166μmol/L to 135μmol/L in one patient,decreased from 152μmol/L to 130μmol/L in another patient,and showed no significant change in the third patient after treatment(155μmol/L vs.146μmol/L).After adjusting immune inhibitor treatment for 2months,BKV quantitative levels dropped significantly from(9.89×10^9),(5.75×10^7)and(3.71×10^8)copies/mL to(5.52×10^4),(4.79×10^4)and(2.58×10^5)copies/mL.The BKV turned negative,and the treatment achieved a satisfactory effect.Conclusion When acute rejection of transplanted kidney and BKV infection occur after kidney transplantation,the former should be solved first since it has a great impact on renal function and prognosis,and the treatment of BKV should also be taken into account.

关 键 词：肾移植 BK病毒感染 急性排斥反应 

分 类 号：R699.2[医药卫生—泌尿科学]