肾移植术后BK病毒阳性免疫抑制剂方案调整分析  

Analysis of the adjustment of BK virus positive immunosuppressive regimen after kidney transplantation

作　　者：刘尊伟[1] 郑瑾[1] 丁晨光[1] 李杨[1] 张静[1] 李潇 任莉[1] 李丹[1] 薛武军[1] Liu Zunwei;Zheng Jin;Ding Chenguang;Li Yang;Zhang Jing;Li Xiao;Ren Li;Li Dan;Xue Wujun(Department of Renal Transplantation,the First Affiliated Hospital of Xi'an Jiaotong University,Shaanxi Xi’an 710061,China)

机构地区：[1]西安交通大学第一附属医院肾移植科,陕西西安710061

出　　处：《实用器官移植电子杂志》2024年第6期548-552,共5页Practical Journal of Organ Transplantation(Electronic Version)

基　　金：国家自然科学基金(82370755)。

摘　　要：目的分析比较病理结果为排斥反应和BK病毒肾病的血BK病毒阳性肾移植受者免疫抑制剂方案调整差异。方法筛选西安交通大学第一附属医院肾移植科2019年6月至2024年5月血BK检测阳性且之后移植肾病理结果为排斥反应和BK病毒肾病的病例,最终纳入32例,依据移植肾病理结果,分为排斥反应组(21例)和BK病毒肾病组(11例)。收集首次血BK阳性时间及DNA定量数值、免疫抑制剂用药及调整方案、调整后血药浓度、病理诊断时间和结果、血BK病毒转阴时间、移植肾功能现况等临床资料进行分析。结果排斥反应组咪唑立宾用量(中位数为100 mg/d)显著小于BK病毒肾病组(中位数为150 mg/d)。另外,排斥反应组血BK阳性至确立病理诊断时间显著长于BK病毒肾病组(P<0.05)。两组移植肾失功率无显著差异(P>0.05)。结论对于血BK持续阳性的肾移植受者,调整免疫抑制方案后排斥反应发生率高,应警惕免疫抑制剂量不足和延迟病理诊断引起的排斥反应,避免移植肾损害的发生。Objective To analyze the difference of immunosuppressant regimen adjustment between renal transplant recipients with pathological results of rejection and BK polyomavirus nephropathy.Methods Thirty two cases were selected from the Kidney Transplantation Department of the First Affiliated Hospital of Xi'an Jiaotong University from June 2019 to May 2024,who tested positive for BK in blood and had subsequent pathological results of rejection and BK virus nephropathy in transplanted kidneys.Based on the pathological results of transplanted kidneys,they were divided into a rejection group(21 cases)and a BK virus nephropathy group(11 cases).The clinical data such as the discovery time and value of plasma BK,adjustment of immunosuppressant regimen,immunosuppressant blood concentration,pathological diagnosis time and results,BK negative time,and transplanted kidney function status were collected and analyzed.Results The dosage of mizoribine in the rejection group(median was 100 mg/d)was significantly lower than that in the BK polyomavirus nephropathy group(median was 150 mg/d).The time from plasma BK detected to pathological diagnosis established was significantly longer than that in the BK polyomavirus nephropathy group(P<0.05).There was no significant difference in loss of transplanted kidney(P>0.05).Conclusion For kidney transplant recipients with persistently plasma BK,the incidence of rejection reactions is higher after adjusting the immunosuppressive regimen.Rejection caused by insufficient immunosuppressive dosage and delayed pathological diagnosis should be avoided to reduce the occurrence of transplanted kidney damage.

关 键 词：BK病毒 排斥反应 免疫抑制剂 移植肾损害 

分 类 号：R699.2[医药卫生—泌尿科学]