肾移植术后主动监测对BK病毒相关性肾病治疗预后的影响  

Effect of active monitoring of BK virus on prognosis of BK virus nephropathy after renal transplantation

作　　者：刘德川 周洪澜[1] 王金国[1] 刘俊彦 朱亚香[1] 于迪 王钢[1] Liu Dechuan;Zhou Honglan;Wang Jinguo;Liu Junyan;Zhu Yaxiang;Yu Di;Wang Gang(The Second Department of Urology,the First Hospital of Jilin University,Changchun 130000,China)

机构地区：[1]吉林大学第一医院泌尿外二科,长春130000

出　　处：《中华移植杂志（电子版）》2021年第4期211-215,共5页Chinese Journal of Transplantation(Electronic Edition)

摘　　要：目的探讨肾移植术后主动规律监测BK病毒(BKV)对BK病毒相关性肾病(BKVN)预后的临床意义。方法选取吉林大学第一医院2015至2018年接受同种异体肾移植术后经病理证实为BKVN的36例受者为研究对象,根据其BKV监测情况分为主动监测组(15例)和被动发现组(21例),观察两组BKV尿症和血症检出时间、BKV DNA载量、BKVN确诊时间,以及治疗后血清和尿液BKV转阴情况和移植肾功能等指标。结果主动监测组受者BKV尿症检出时间为术后(5.3±3.4)个月,BKV血症检出时间为术后(7.8±3.8)个月,BKVN确诊时间为术后(10.3±7.4)个月,均早于被动发现组[(12.6±2.7)、(15.3±13.6)和(19.9±10.2)个月],差异均有统计学意义(t=0.024、0.013和0.027,P均<0.05)。经治疗后主动监测组和被动发现组血清BKV转阴(14/15和11/21)和尿液BKV转阴(12/15和10/21)的受者比例差异均有统计学意义(χ^(2)=0.029和0.012,P均<0.05)。同时,主动监测组尿液BKV转阴时间为治疗后(3.3±3.2)个月,血清BKV转阴时间为治疗后(0.8±0.7)个月,均早于被动发现组[(5.6±2.1)和(3.6±2.1)个月],差异均有统计学意义(t=0.041和0.027,P均<0.05)。主动监测组发生移植肾失功/功能不全的受者比例(4/15)低于被动发现组(13/21),差异有统计学意义(χ^(2)=0.015,P<0.05)。结论肾移植术后主动、规律开展BKV监测,有助于尽早确诊BKVN、提高BKV转阴比例和缩短BKV转阴时间,以及减少移植肾失功的发生。Objective To investigate the clinical significance of regular monitoring of BK virus(BKV)infection on the prognosis of BK virus nephropathy(BKVN)after renal transplantation.Methods Thirty-six renal transplant recipients with pathologically confirmed BKVN from 2015 to 2018 in our center were selected as the research objects.According to their BKV monitoring,the recipients were divided into active monitoring group(15 cases)and passive discovery group(21 cases).The detection time of BKV urination and blood,BKVDNA load,time to diagnosis of BKVN,serum and urine BKV conversion after treatment and renal allograft function were observed in the two groups.Results The detection time of BKV,BKV and BKVN was(5.3±3.4)months,(7.8±3.8)months and(10.3±7.4)months,respectively.There were significant differences in the proportion of recipients with serum BKV conversion(14/15 and 11/21)and urine BKV conversion(12/15 and 10/21)in the passive monitoring group after treatment(χ^(2)=0.029 and 0.012,P<0.05).The time of urine BKV conversion in the subjective monitoring group was(3.3±3.2)months after treatment,and the time of serum BKV conversion was(0.8±0.7)months after treatment,which were earlier than those in the passive discovery group[(5.6±2.1)months and(3.6±2.1)months],and the differences were statistically significant(t=0.041 and 0.027,all P<0.05).The proportion of recipients who developed renal allograft failure/insufficiency was lower in the active monitoring group(4/15)than in the passive discovery group(13/21),and the difference was statistically significant(χ^(2)=0.015,P<0.05).Conclusions Active and regular monitoring of BKV after renal transplantation is helpful for early diagnosis of BKVN,increasing the proportion of BKV conversion,shortening the time of BKV conversion and reducing the occurence of renal allograft failure.

关 键 词：肾移植 BK病毒血症 BK病毒尿症 BK病毒相关性肾病 移植肾活检 

分 类 号：R699.2[医药卫生—泌尿科学]