中华器官移植杂志
中華器官移植雜誌
중화기관이식잡지
CHINESE JOURNAL OF ORGAN TRANSPLANTATION
2008年
6期
350-354
,共5页
黄刚%陈立中%王长希%费继光%邱江%李军%邓素雄%陈国栋%曾文涛%付茜%纪玉莲
黃剛%陳立中%王長希%費繼光%邱江%李軍%鄧素雄%陳國棟%曾文濤%付茜%紀玉蓮
황강%진립중%왕장희%비계광%구강%리군%산소웅%진국동%증문도%부천%기옥련
肾移植%BK病毒%感染%Decoy细胞
腎移植%BK病毒%感染%Decoy細胞
신이식%BK병독%감염%Decoy세포
Kidney transplantation%BK virus%Infection%Decoy cells
目的 探讨肾移植术后受者BK病毒感染的检测方法及免疫抑制方案对BK病毒活化的影响.方法 选择1999年1月至2007年1月问进行肾移植术的200例受者为研究对象,其中100例基础免疫抑制方案为他克莫司(FK506)十霉酚酸酯(MMF)的受者作为密切观察组;另100例基础免疫抑制方案不同、但在年龄和术后是否发生急性排斥反应方面与密切观察组受者相一致(按1:1匹配)的受者作为对照观察组.在肾移植术后平均15.3个月时,分别采集所有受者的血、尿样本,行BK病毒尿沉渣Decoy细胞计数与BK病毒DNA含量的检测.分析和比较尿Decoy细胞计数、尿BK病毒含量及血BK病毒含量之间的关系;比较两组Decoy细胞、BK病毒尿症与BK病毒血症阳性率的差异.结果 200例受者的尿Decoy细胞、BK病毒尿症与病毒血症的阳性率分别为:34.0%、36.0%和16.5%.尿Decoy细胞计数与尿BK病毒含量呈正相关(r=0.714,P＜0.001),但尿液和外周血中BK病毒含量无明显相关性(P＞0.05).密切观察组的尿Decoy细胞、BK病毒尿症与BK病毒血症的阳性率分别为49%、50%和24%,对照观察组上述指标的阳性率分别是19%、22%和9%,两组的差异有统计学意义(P＜0.01).结论 尿沉渣Decoy细胞计数方法简单、易行并敏感,可以做为BK病毒活化的指标;血、尿BK病毒DNA的检测可进一步了解病毒活化情况、筛杳BK病毒相关的移植肾肾病.FK506+MMF的组合免疫抑制方案易发生BK病毒的活化,受者术后需进行密切观察和相关的检测.
目的 探討腎移植術後受者BK病毒感染的檢測方法及免疫抑製方案對BK病毒活化的影響.方法 選擇1999年1月至2007年1月問進行腎移植術的200例受者為研究對象,其中100例基礎免疫抑製方案為他剋莫司(FK506)十黴酚痠酯(MMF)的受者作為密切觀察組;另100例基礎免疫抑製方案不同、但在年齡和術後是否髮生急性排斥反應方麵與密切觀察組受者相一緻(按1:1匹配)的受者作為對照觀察組.在腎移植術後平均15.3箇月時,分彆採集所有受者的血、尿樣本,行BK病毒尿沉渣Decoy細胞計數與BK病毒DNA含量的檢測.分析和比較尿Decoy細胞計數、尿BK病毒含量及血BK病毒含量之間的關繫;比較兩組Decoy細胞、BK病毒尿癥與BK病毒血癥暘性率的差異.結果 200例受者的尿Decoy細胞、BK病毒尿癥與病毒血癥的暘性率分彆為:34.0%、36.0%和16.5%.尿Decoy細胞計數與尿BK病毒含量呈正相關(r=0.714,P＜0.001),但尿液和外週血中BK病毒含量無明顯相關性(P＞0.05).密切觀察組的尿Decoy細胞、BK病毒尿癥與BK病毒血癥的暘性率分彆為49%、50%和24%,對照觀察組上述指標的暘性率分彆是19%、22%和9%,兩組的差異有統計學意義(P＜0.01).結論 尿沉渣Decoy細胞計數方法簡單、易行併敏感,可以做為BK病毒活化的指標;血、尿BK病毒DNA的檢測可進一步瞭解病毒活化情況、篩杳BK病毒相關的移植腎腎病.FK506+MMF的組閤免疫抑製方案易髮生BK病毒的活化,受者術後需進行密切觀察和相關的檢測.
목적 탐토신이식술후수자BK병독감염적검측방법급면역억제방안대BK병독활화적영향.방법 선택1999년1월지2007년1월문진행신이식술적200례수자위연구대상,기중100례기출면역억제방안위타극막사(FK506)십매분산지(MMF)적수자작위밀절관찰조;령100례기출면역억제방안불동、단재년령화술후시부발생급성배척반응방면여밀절관찰조수자상일치(안1:1필배)적수자작위대조관찰조.재신이식술후평균15.3개월시,분별채집소유수자적혈、뇨양본,행BK병독뇨침사Decoy세포계수여BK병독DNA함량적검측.분석화비교뇨Decoy세포계수、뇨BK병독함량급혈BK병독함량지간적관계;비교량조Decoy세포、BK병독뇨증여BK병독혈증양성솔적차이.결과 200례수자적뇨Decoy세포、BK병독뇨증여병독혈증적양성솔분별위:34.0%、36.0%화16.5%.뇨Decoy세포계수여뇨BK병독함량정정상관(r=0.714,P＜0.001),단뇨액화외주혈중BK병독함량무명현상관성(P＞0.05).밀절관찰조적뇨Decoy세포、BK병독뇨증여BK병독혈증적양성솔분별위49%、50%화24%,대조관찰조상술지표적양성솔분별시19%、22%화9%,량조적차이유통계학의의(P＜0.01).결론 뇨침사Decoy세포계수방법간단、역행병민감,가이주위BK병독활화적지표;혈、뇨BK병독DNA적검측가진일보료해병독활화정황、사묘BK병독상관적이식신신병.FK506+MMF적조합면역억제방안역발생BK병독적활화,수자술후수진행밀절관찰화상관적검측.
Objective To investigate the methods for clinical diagnosis of BK virus (BKV) infection and to analyze the influence of immunosuppressive protocol on BKV activation in renal transplant recipients. Methods 200 renal recipients receiving renal transplantation during 1999. 1-2007. 1 were selected as objectives, among which, 100 cases subject to FKS06 + MMF protocol were regarded as the intensive observation group; with different immunosuppressive protocol, but the same age and the occurrence of the acute rejection as those of the intensive observation group, the other 100 recipients served as control observation group. 15.3 months, on the average after kidney transplantation,the urine and peripheral blood (PB) samples of 200 renal transplant recipients were taken for the BKV cytological test of urinary sediment and real-time PCR for BKV DNA of both urine and PB in order to analyze the relationship among the amount of decoy cells in urine, the BKV load in urine and the BKV load in PB and compare the positive rate of urine decoy cell, BKV viruria and viremia between the above two groups. Results The positive rate of urine decoy cell, BKV viruria and viremia in all patients were 34%, 36% and 16%, respectively. The amount of deooy cells in urine samples was related to the BKV load in urine samples (r=0.714, P＜0.001), but the BKV load in urine samples was not related to that in PB samples (P=0.14). The positive rate of urine decoy cell, BKV viruria and viremia in the intensive observation group were 49%, 50% and 24%, and in control observation group 19%, 22% and 9%, respectively, with the difference being significant between two groups.Conclusions Urine cytology is very convenient, useful and sensitive for the evaluation of BKV replication. Also BKV DNA detection in the urine and peripheral blood is important to screen the evidence of BK reaction further in order to prevent irreversible graft damage of BKVAN. Using FK506 + MMF can increase the infection rate of BKV in renal transplant recipients, and intensively BKV monitoring is necessary for these recipients.
