同种异体肾移植术后BK病毒感染的危险因素  

Risk factors for BK virus infection in patients undergoing allogeneic kidney transplantation

作　　者：马媛[1] 李冰玉[1] 马宁 史佳佳[1] 梁亚林[1] MA Yuan;LI Bing-yu;MA Ning;SHI Jia-jia;LIANG Ya-lin(Zhengzhou Seventh People′s Hospital,Zhengzhou,Henan 450000,China;不详)

机构地区：[1]郑州市第七人民医院肾移植肾内科,河南郑州450000 [2]郑州大学第一附属医院心血管外二科,河南郑州450000

出　　处：《中华医院感染学杂志》2021年第17期2687-2691,共5页Chinese Journal of Nosocomiology

基　　金：河南省医学科技攻关计划基金资助项目(LHGJ20191119)。

摘　　要：目的探究同种异体肾移植术患者BK病毒(BKV)感染的危险因素及其与淋巴细胞计数、他克莫司(Tac)浓度水平的关系。方法选择2014年4月-2019年8月郑州市第七人民医院肾移植科收治的132例进行同种异体肾移植手术患者作为研究对象,所有患者均行免疫抑制治疗。于肾移植术后监测血肌酐、尿素氮、胱抑素-C、Tac浓度、BKV载量,测定外周血淋巴细胞计数,统计BKV感染情况,分析引起感染的危险因素及上述指标诊断感染的临床价值。结果132例肾移植患者中,共26例患者尿液BKV阳性;其中2例血浆BKV阳性;BKV阳性组患者血肌酐、胱抑素C、尿素氮水平均高于BKV阴性组患者(P<0.05),BKV阳性组患者Tac浓度高于BKV阴性患者,淋巴细胞计数低于BKV阴性患者(P<0.05);多因素Logistic回归分析显示,Tac浓度、淋巴细胞计数是肾移植患者BKV感染的影响因素(P<0.05)。受试者工作特征曲线(ROC)分析结果,Tac浓度、淋巴细胞计数、肌酐、胱抑素C、尿素氮诊断BKV感染的曲线下面积(AUC)分别为0.685、0.694、0.800、0.722、0.754。结论同种异体肾移植术患者存在较高BKV感染风险,与Tac浓度、淋巴细胞计数等水平密切相关,临床可根据Tac浓度、淋巴细胞计数等指标诊断并评估BKV感染情况。OBJECTIVE To explore the risk factors for BK virus(BKV)infection in patients undergoing allogeneic kidney transplantation and their relationship with lymphocyte count and tacrolimus(Tac)concentration.METHODS A total of 132patients who underwent allogeneic kidney transplantation in the Zhengzhou Seventh People′s Hospital from Apr 2014to Aug 2019were recruited as the study subjects,and all of the patients received immunosuppressive therapy.The concentrations of serum creatinine,urea nitrogen,cystatin-C and Tac as well as BKV load were monitored after the renal transplantation,the peripheral blood lymphocytes counts were determined,the prevalence rates of BKV infection were statistically analyzed,and the risk factors for the infection and clinical value of the above indexes in diagnosis of infection were observed.RESULTS Among the 132patients undergoing renal transplantation,26were positive for BKV test in urine,2of whom were positive for plasma BKV test.The levels of serum creatinine,cystatin C and urea nitrogen of the BKV-positive group were significantly higher than those of the BKV-negative group(P<0.05),the Tac concentration of the BKV-positive group was significantly higher than that of the BKV-negative group,and the lymphocyte counts of the BKV-positive group were significantly significantly less than those of the BKV-negative group(P<0.05).Multivariate logistic regression analysis showed that the Tac concentration and lymphocyte counts were the influencing factors for the BKV infection in the renal transplantation patients(P<0.05).The result of receiver operating characteristic(ROC)curve analysis indicated that areas under curve(AUCs)of Tac concentration,lymphocyte counts,creatinine,cystatin C and urea nitrogen were respectively 0.685,0.694,0.800,0.722and 0.754in diagnosis of BKV infection.CONCLUSION The patients undergoing allogeneic kidney transplantation are at high risk of BKV infection,which is closely associated with the Tac concentration and lymphocyte counts.It is necessary for the hospital to diag

关 键 词：肾移植 免疫抑制 BK病毒 淋巴细胞计数 他克莫司 

分 类 号：R6193[医药卫生—外科学]