肾移植术患者BK病毒感染DNA载量与肾功能损伤程度的关系  

Study on the correlation between BKV DNA load and renal function impairment in kidney transplant patients

作　　者：杨青彦[1] 刘君毅[1] 殷正伟 杨俊伟[1] 索敬钧 王长安[1] 王晓勃[1] 李涛 YANG Qing-yan;LIU Jun-yi;YIN Zheng-wei;YANG Jun-wei;SUO Jing-jun;WANG Chang-an;WANG Xiao-bo;LI Tao(Center of Renal Transplantation and Kidney Disease,the Seventh People′s Hospital of Zhengzhou,Zhengzhou 450000,Henan,China)

机构地区：[1]郑州市第七人民医院肾移植肾脏病诊疗中心,河南郑州450000

出　　处：《广东医学》2025年第1期72-76,共5页Guangdong Medical Journal

基　　金：河南省医学科技攻关计划联合共建项目(LHGJ20210757)。

摘　　要：目的探讨肾移植术后患者BK病毒(BKV)感染DNA载量(BKV-DNA)与患者肾功能损伤程度的关系。方法本研究采用回顾性病例对照分析方法,选取2020年2月至2023年2月郑州市第七人民医院实施肾移植手术治疗且BKV感染阳性的76例患者作为BK组,另外选取83例肾移植且BKV阴性患者作为对照组,对比分析两组患者手术后不同时间的肾小球滤过率(eGFR)、血清胱抑素C(Cys-C)、血肌酐(Scr)水平差异,并根据BKV-DNA进行分层对比。根据患者在肾移植术后3个月内是否出现Scr水平>400μmol/L判断肾功能是否异常,采用多因素分析法探讨BKV-DNA肾功能移植术后肾功能异常发生的关系。结果BK组在手术后1个月、3个月的eGFR水平均低于对照组,Scr、Cys-C水平均高于对照组,两组之间差异具有统计学意义(P<0.05)。76例BKV感染的肾移植手术患者,经病毒载量分析,其中病毒低载量患者46例、高载量患者30例,高载量组在手术后1个月、3个月的eGFR水平均低于低载量组,Scr、Cys-C水平均高于低载量组,两组之间差异具有统计学意义(P<0.05)。二元logistic回归模型进行分析显示:术前血红蛋白(Hb)降低、肾移植术前输血、采取髂外动脉吻合、热缺血时间≥10 min、BKV感染是肾移植手术患者术后出现肾功能损伤的独立危险因素(P<0.05)。结论肾移植术后患者发生BKV感染会显著增大术后肾功能损伤的风险,同时肾功能损伤程度与BKV载量有密切关系。Objective To investigate the relationship between BK virus(BKV)DNA load and the degree of renal function impairment in kidney transplant recipients.Methods A retrospective case-control study was conducted on 76 kidney transplant patients with positive BKV infection(BK group)and 83 BKV-negative transplant recipients(control group)at the Seventh People′s Hospital of Zhengzhou.Serum biomarkers such as glomerular filtration rate(eGFR),cystatin C(Cys-C),and serum creatinine(Scr)were compared between the two groups at different postoperative time points.BKV-DNA levels were stratified into low-load and high-load subgroups for further analysis.Renal function impairment was defined as Scr>400μmol/L within three months post-transplant.Multivariate analysis was performed to evaluate factors associated with impaired renal function post-transplant.Results The BK group exhibited significantly lower eGFR and higher Scr and Cys-C levels than the control group at one and three months post-transplant(P<0.05).Among the BK group,46 patients had low BKV-DNA load,and 30 had high load.Patients with high viral load demonstrated lower eGFR and higher Scr and Cys-C levels compared to the low-load group at one and three months post-transplant(P<0.05).Multivariate logistic regression identified decreased preoperative hemoglobin,preoperative blood transfusion,external iliac artery anastomosis,warm ischemia time≥10 minutes,and BKV infection as independent risk factors for renal function impairment(P<0.05).Conclusion BKV infection in kidney transplant recipients significantly increases the risk of postoperative renal function impairment.Furthermore,the severity of renal dysfunction correlates with BKV DNA load,emphasizing the importance of early monitoring and management of BKV in this patient population.

关 键 词：肾移植 BK病毒 病毒载量 肾功能损伤 肾小球滤过率 胱抑素C 血肌酐 

分 类 号：R692.5[医药卫生—泌尿科学] R692.3[医药卫生—外科学]