南方医科大学学报

南方医科大学学报 ›› 2019, Vol. 39 ›› Issue (01): 120-.doi: 10.12122/j.issn.1673-4254.2019.01.19

• • 上一篇    下一篇

BK多瘤病毒在肾移植受者中的感染特征

周易，姚雷雨，于哲，崔乃千，符芳翔，叶悦典，邓文锋，徐健，付绍杰，刘如敏，于立新，苗芸   

  • 出版日期:2019-01-20 发布日期:2019-01-20

Characteristics of BK polymavirus infection in kidney transplant recipients

  • Online:2019-01-20 Published:2019-01-20

HTML

PDF

1809

摘要： 目的探讨肾移植受者术后BK多瘤病毒的感染特征和干预时机。方法回顾性分析2013年1月~2018年1月在本中心检测尿液 BKV载量≥1.0×104 copy/mL的157例肾移植受者的临床资料，选择69例同期接受移植且尿液BKV载量始终<1.0×104 copy/mL 肾移植受者作为对照。结果157例BKV感染再激活受者中出现尿BKV阳性60例（38.2%）、BKV尿症66例（42.0%）、BKV血 症31例（19.7%）。BKV阳性患者与BKV阴性患者相比，尿隐血阳性率更高，差异有统计学意义（P<0.05）。受者尿液BKV载量 变化率与他克莫司谷值血药浓度变化率呈正相关（r2=0.351, P<0.05）。首次发现BKV再激活时，BKV阳性患者平均eGFR低于 基线水平（eGFR=60 mL/min·1.73 m-2）。干预后至末次随访，尿BKV阳性组平均eGFR可恢复至正常值，BKV尿症组和BKV血症 组肾功能有所改善但均未达到基线水平。结论肾移植术后部分受者尿隐血阳性与BKV再激活状态相关，BKV载量对免疫抑制 剂血药浓度的改变敏感。在BKV复制早期进行干预，适度减少免疫抑制剂剂量，能够有效控制BKV复制、维持移植肾功能。

Abstract: Objective To analyze the characteristics of BK polymavirus (BKV) infection and the optimal time window for intervention in kidney transplant recipients (KTRs). Methods We retrospectively analyzed the clinical data and treatment regimens in 226 KTRs in our center between January, 2013 and January, 2018. Among the recipients, 157 had a urine BKV load ≥1.0×104 copy/mL after transplantation, and 69 had a urine BKV load below 1.0×104 copy/mL (control group). Results Among the 157 KTRs, 60 (38.2%) recipients were positive for urine BKV, 66 (42.0%) had BKV viruria, and 31(19.7%) had BKV viremia. The incidence of positive urine occult blood was significantly higher in BKV-positive recipients than in the control group (P<0.05). The change of urine BKV load was linearly related to that of Tacrolimus trough blood level (r2=0.351, P<0.05). In urine BKV positive group, the average estimated glomerular filtration rate (eGFR) was below the baseline level (60 mL· min-1 · 1.73 m-2) upon diagnosis of BKV infection reactivation, and recovered the normal level after intervention. In patients with BKV viruria and viremia, the average eGFR failed to return to the baseline level in spite of improvement of the renal function after intervention. Conclusion Positive urine occult blood after transplantation may be associated with BKV infection reactivation in some of the KTRs. BKV infection is sensitive to changes of plasma concentration of immunosuppressive agents. Early intervention of BKV replication in KTRs with appropriate dose reduction for immunosuppression can help to control virus replication and stabilize the allograft function.