肾移植术后高水平BK病毒尿症危险因素分析  

Analysis of risk factors of high-level BK viruria after renal transplantation

作　　者：熊睿[1,2] 丁利民[1] 杨华[1] 李新长 Xiong Rui;Ding Limin;Yang Hua;Li Xinchang(Department of Organ Transplantation,Jiangxi Provincial People's Hospital Affiliated to Nanchang University,Nanchang 330006,China)

机构地区：[1]南昌大学附属江西省人民医院器官移植科,330006 [2]南昌大学江西医学院

出　　处：《器官移植》2021年第3期317-323,共7页Organ Transplantation

基　　金：江西省科技厅重点研发项目基金(20151BBG70069)。

摘　　要：目的分析肾移植术后高水平BK病毒尿症的危险因素及其对预防BK病毒相关性肾病(BKVAN)的意义。方法回顾性分析262例保留规律随访资料的肾移植受者的临床资料。根据受者BK病毒DNA载量分为高水平BK病毒尿症组(35例)和非高水平BK病毒尿症组(227例)。总结肾移植术后高水平BK病毒尿症的发生情况;采用单因素和多因素分析肾移植术后发生高水平BK病毒尿症的危险因素;采用Kaplan-Meier法绘制生存曲线,对受者进行生存分析。结果262例肾移植受者中,35例发生高水平BK病毒尿症,发生率为13.4%。发生中位时间181(126,315)d,发生率在移植术后6个月内最高,6个月至2年逐渐降低,2年后有所回升。单因素分析结果提示抗胸腺细胞球蛋白(ATG)治疗史、急性排斥反应(AR)、捐献类型及移植物功能延迟恢复(DGF)是肾移植术后发生高水平BK病毒尿症的危险因素(均为P<0.05)。多因素Cox回归分析结果显示脑-心双死亡器官捐献(DBCD)、AR及DGF是肾移植术后发生高水平BK病毒尿症的独立危险因素。有ATG治疗史、发生AR、发生DGF以及捐献类型为DBCD的受者的1、3、5年生存率分别低于无ATG治疗史、无发生AR、无发生DGF及其他捐献类型[脑死亡器官捐献(DBD)、心脏死亡器官捐献(DCD)和活体器官捐献]的受者(均为P<0.05)。结论DBCD、AR及DGF是肾移植术后发生高水平BK病毒尿症的独立危险因素,加强对此类受者的术后监测并给予早期干预可能是预防BKVAN的有效方式。Objective To analyze the risk factors of high-level BK viruria after renal transplantation and the significance in preventing BK virus-associated nephropathy(BKVAN).Methods Clinical data of 262 renal transplant recipients with regular follow-up data were retrospectively analyzed.According to the DNA load of BK virus,all recipients were divided into the high-level BK viruria group(n=35)and non-high-level BK viruria group(n=227).The incidence of high-level BK viruria after renal transplantation was summarized.The risk factors of high-level BK viruria after renal transplantation were analyzed by univariate analysis and multivariate analysis.Survival curve was delineated by Kaplan-Meier method,and survival analysis of recipients was performed.Results Among 262 renal transplant recipients,35 cases developed high-level BK viruria with an incidence of 13.4%.The median time of occurrence of high-level BK viruria was 181(126,315)d.The incidence was the highest within 6 months after renal transplantation,gradually decreased from 6 months to 2 years,and then increased after 2 years.Univariate analysis showed that the history of antithymocyte globulin(ATG)treatment,acute rejection(AR),donation type and delayed graft function(DGF)were the risk factors of high-level BK viruria after renal transplantation(all P<0.05).Multivariate Cox regression analysis demonstrated that donation after brain death followed by cardiac death(DBCD),AR and DGF were the independent risk factors of high-level BK viruria after renal transplantation.The 1-,3-and 5-year survival rates of recipients with ATG treatment history,AR,DGF and donation type of DBCD were significantly lower than those with non-ATG treatment history,non-AR,non-DGF and other donation types[donation after brain death(DBD),donation after cardiac death(DCD)and living organ donation]respectively(all P<0.05).Conclusions DBCD,AR and DGF are the independent risk factors of high-level BK viruria after renal transplantation.Strengthening the postoperative monitoring of these recipients and

关 键 词：肾移植 BK病毒 BK病毒尿症 BK病毒血症 BK病毒相关性肾病(BKVAN) 急性排斥反应(AR) 移植物功能延迟恢复(DGF) 脑-心双死亡器官捐献(DBCD) 

分 类 号：R617[医药卫生—外科学] R692[医药卫生—临床医学]