44例肾移植术后多瘤病毒相关性肾病患者的临床病理特征和预后分析  

Clinicopathological features and prognostic analysis of 44 patients with polyomavirus nephropathy after kidney transplantation

作　　者：王子沛 郭晖[1] 张波[1] 唐玉坤 蒋继贫[1] 周平[1] 杜敦峰[1] Wang Zipei;Guo Hui;Zhang Bo;Tang Yukun;Jiang Jipin;Zhou Ping;Du Dunfeng(Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Key Laboratory of Organ Transplantation of Ministry of Education,Key Laboratory of Organ Transplantation of National Health Commission,Key Laboratory of Organ Transplantation of Chinese Academy of Medical Sciences,Wuhan 430030,China)

机构地区：[1]华中科技大学同济医学院附属同济医院、器官移植教育部重点实验室、国家卫生健康委员会器官移植重点实验室、中国医学科学院器官移植重点实验室,武汉430030

出　　处：《器官移植》2023年第3期389-396,共8页Organ Transplantation

基　　金：湖北省重点研发项目(2022BCA015);湖北省卫生健康委2021-2022年项目(WJ2021C001)。

摘　　要：目的探讨肾移植术后多瘤病毒相关性肾病(PyVN)的临床病理学特征及预后。方法回顾性分析44例肾移植术后确诊PyVN患者的临床资料,分析患者穿刺原因及病理学诊断时间。按Banff 2018标准进行组织学分级,比较各级患者临床资料及病理特征。分析患者血、尿BK病毒DNA载量及移植肾功能。比较各组患者的预后情况,分析影响预后的危险因素。结果患者病理诊断PyVN距肾移植手术时间为16(8,29)个月,血清肌酐升高为穿刺的主要原因。44例患者中,PyVN 1级19例、2级21例、3级4例,各组光学显微镜下病毒包涵体阳性率差异无统计学意义(P=0.148),2级患者炎症细胞浸润、间质纤维化、肾内多瘤病毒载量均多于或高于1级患者,3级患者炎症细胞浸润及肾内多瘤病毒载量多于或高于1级患者,3级患者肾内多瘤病毒载量多于或高于2级患者,差异均有统计学意义(均为P<0.05/3)。确诊时39例患者具有血、尿BK病毒DNA载量检测记录,其中38例尿BK病毒阳性,30例血BK病毒阳性。患者确诊PyVN时血清肌酐较术后1个月升高,末次随访时血清肌酐较确诊PyVN时升高,差异均有统计学意义(P<0.001、P=0.049)。不同级别PyVN患者术后1个月血清肌酐差异无统计学意义(P=0.554),确诊时2级患者血清肌酐水平高于1级患者(P=0.007)。肾移植术后1、3、5年移植肾累积存活率分别为95%、69%、62%,不同分级PyVN间移植肾存活率差异有统计学意义,分级越高,存活率越低(P=0.014)。单因素和多因素Cox回归分析提示肾内多瘤病毒载量、确诊时血清肌酐水平为移植肾失功的独立危险因素(均为P<0.05)。结论PyVN多发生在肾移植术后2年内,临床表现以血清肌酐升高、BK病毒血症和BK病毒尿症为主,术后常规监测BK病毒有利于早期诊断并保护移植肾,Banff 2018分级标准可有效预测移植肾预后。Objective To analyze the clinicopathological features and prognosis of polyomavirus nephropathy(PyVN)after kidney transplantation.Methods Clinical data of 44 patients who were diagnosed with PyVN after kidney transplantation were retrospectively analyzed.The causes of puncture and the time of pathological diagnosis were analyzed.Histological grading was carried out according to Banff 2018 classification.Clinical data and pathological characteristics of patients at all grades were statistically compared.BK viral DNA loads in the blood and urine were measured and renal allograft function were assessed.Clinical prognosis of all patients was compared among different groups and the risk factors affecting clinical prognosis were also analyzed.Results The time interval between pathological diagnosis of PyVN and kidney transplantation was 16(8,29)months,and the increase of serum creatinine level was the main cause for puncture.Among 44 patients,19 cases were classified as gradeⅠPyVN,21 cases of gradeⅡPyVN and 4 cases of gradeⅢPyVN,respectively.Under optical microscope,there was no significant difference in the positive rate of virus inclusion bodies among different groups(P=0.148).Inflammatory cell infiltration,interstitial fibrosis and polyomavirus load in gradeⅡPyVN patients were all more or higher than those in gradeⅠcounterparts.Inflammatory cell infiltration and polyomavirus load in gradeⅢpatients were more or higher than those in gradeⅠcounterparts.Polyomavirus load in gradeⅢpatients was more or higher than that in gradeⅡcounterparts.The differences were statistically significant(all P<0.05/3).Upon diagnosis,BK viral DNA load was detected in the blood and urine of 39 patients.Among them,38 patients were positive for BK virus in the urine and 30 patients were positive for BK virus in the blood.The serum creatinine level upon diagnosis was higher compared with that at postoperative 1 month.The serum creatinine level at the final follow-up was significantly higher than that upon diagnosis.The differe

关 键 词：肾移植 多瘤病毒相关性肾病 BK病毒 Banff标准 移植病理学 病毒载量 间质纤维化 血清肌酐 

分 类 号：R617[医药卫生—外科学] R361[医药卫生—临床医学]