肾移植术后BK病毒感染危险因素分析  

Risk factors of BK virus infection after kidney transplantation

作　　者：张泽华 王钰雄 刘斌[1] 王尚国 苏晓晨 周洪澜[1] Zhang Zehua;Wang Yuxiong;Liu Bin;Wang Shangguo;Su Xiaochen;Zhou Honglan(The second Department of Urology,the first hospital of Jilin University,Changchun 130021,China)

机构地区：[1]吉林大学第一医院泌尿外二科,长春130021

出　　处：《中华器官移植杂志》2022年第9期519-524,共6页Chinese Journal of Organ Transplantation

基　　金：吉林省财政厅项目(JLSWSRCZX2021-015、JLSWSRCZX2020-020)。

摘　　要：目的分析肾移植术后受者的BK病毒(BKV)感染的危险因素,为肾移植术后BKV感染的预防及早期诊断提供参考。方法回顾性分析2018年1月1日至2020年12月31日吉林大学第一医院完成的561例肾移植受者(器官捐献和活体供肾)的临床信息及术后18个月随访资料,根据定量聚合酶链式反应测定的血、尿标本中BKV DNA载量以及移植肾活检结果,将受者分为对照组(A组,BKV监测结果阴性或尿液中BKV DNA载量<1.0×10^(7)拷贝/ml,372例)、高水平BKV尿症组(B组,尿液中BKV DNA载量≥1.0×10^(7)拷贝/ml但血BKV阴性,128例)、BKV血症组(C组,血清BKV DNA载量≥1.0×10^(3)拷贝/ml,52例)、BK病毒相关性肾病(BKVN)组(D组,移植肾活组织病理检查明确BKVN,9例)。统计分析术后BKV感染的独立危险因素。结果在术后18个月内,561例肾移植受者高水平BKV尿症发生率为33.69%(189/561),检出时间为术后(4.2±3.8)个月;BKV血症发生率为10.87%(61/561),检出时间为术后(5.2±3.6)个月;BKVN发生率为1.78%(10/561),检出时间为术后(7.0±4.0)个月;单因素分析提示受者性别、年龄、免疫抑制方案、急性排斥反应史、供者类型与BKV感染有关;纳入多因素Logistic回归后;男性受者(P=0.013)、他克莫司+吗替麦考酚酯+糖皮质激素联用的免疫维持方案(P<0.001)和急性排斥反应史(P=0.002)是术后BKV感染发生发展的独立危险因素。结论肾移植术后12个月内是BKV感染的高发期,男性受者、急性排斥反应史、免疫抑制方案是肾移植术后BKV感染的独立危险因素。Objective To retrospectively analyze the BKV infection of recipients after kidney transplantation(RT)and provide references for diagnosing and treating BK virus infection post-RT.Methods From January 1,2018 to December 31,2020,clinical and follow-up data were reviewed for 561 RT recipients(cadaveric and living donor kidney)at First Hospital of Jilin University.DNA loading of BK virus in blood and urine was determined by quantitative polymerase chain reaction(qPCR)and kidney allograft biopsy performed.Based upon the results,they are divided into four groups of A(372 cases),high-level BK viruria(group B,128 cases),BK viremia(group C,52 cases)and BK virus nephropathy(BKVN)(group D,9 cases).The variables related to BK virus infection were screened by univariate analysis.Meaningful variables(P<0.1)are incorporated into the multi-factor ordered Logistic regression model for examining the independent risk factors of postoperative BK virus infection.Results The incidence of high-level BKV viruria is 33.69%(189/561)at 18 months post-RT.The average detection time is(4.2±3.8)months,the incidence of BK viremia 10.87%(61/561)and the average detection time(5.2±3.6)months post-RT.The incidence of BKVN is 1.78%(9/561)and the average detection time(7.0±4.0)months post-RT.Univariate analysis showed that gender,age,immunotherapeutic regimen,history of acute rejection and type of donor are correlated with BKV infection.Multivariate Logistic regression analysis indicated that male recipient(P=0.013),immune maintenance regimen(P<0.001)and history of acute rejection(P=0.002)were independent risk factors for developing postoperative BKV infection.Conclusions There is a high incidence of BKV infection within 12 months post-RT.Male recipient,history of acute rejection and immune maintenance regimen are independent risk factors for BKV infection post-RT.

关 键 词：肾移植 BK病毒 危险因素 

分 类 号：R699.2[医药卫生—泌尿科学]