CAJ | 학술논문

目的探讨肾移植后BK病毒相关性肾病(BKVAN)的临床诊断特点及无创检测对于预测不同病理分期BKVAN的临床意义.方法选择2006年1月至2013年8月接受移植肾穿刺活检的479例肾移植受者,进行尿沉渣Decoy细胞计数;同时检测尿、血标本中BK病毒DNA含量.并且运用常规病理染色、免疫组织化学染色的方法检查移植肾组织,确定BKVAN的诊断,并进行BKVAN病理分期.比较不同的诊断方法预测不同病理分期BKVAN的临床意义.结果 479例受者中共诊断BKVAN 39例,发生率为8.1％(39/479),其中BKVAN A期9例,B期25例,C期5例.免疫抑制方案均为他克莫司+吗替麦考酚酯+皮质激素.确诊时血肌酐水平出现不同程度上升(平均为194.9 μmol/L),尿比重降低(平均为1.007),34例受者尿蛋白阴性.BKVAN组的尿沉渣Decoy细胞阳性率、BK病毒尿症、BK病毒血症及BK病毒DNA阳性率均高于非BKVAN组(P＜0.05).尿Decoy细胞预测BKVAN的阴性预测值为0.949,敏感度为0.995,均最高;BK病毒血症预测BKVAN的阳性预测值为0.770,特异性为0.977,均最高.三项筛查指标预测BKVAN B期的敏感性、特异性、阳性预测值、阴性预测值最高.结论尿沉渣细胞学结合BK病毒DNA的血、尿检测,并注意观察肾移植受者常规随访检查的细节,可以及时发现移植肾BKVAN.
목적 탐토신이식후BK병독상관성신병(BKVAN)적림상진단특점급무창검측대우예측불동병리분기BKVAN적림상의의.방법 선택2006년1월지2013년8월접수이식신천자활검적479례신이식수자,진행뇨침사Decoy세포계수;동시검측뇨、혈표본중BK병독DNA함량.병차운용상규병리염색、면역조직화학염색적방법검사이식신조직,학정BKVAN적진단,병진행BKVAN병리분기.비교불동적진단방법예측불동병리분기BKVAN적림상의의.결과 479례수자중공진단BKVAN 39례,발생솔위8.1％(39/479),기중BKVAN A기9례,B기25례,C기5례.면역억제방안균위타극막사+마체맥고분지+피질격소.학진시혈기항수평출현불동정도상승(평균위194.9 μmol/L),뇨비중강저(평균위1.007),34례수자뇨단백음성.BKVAN조적뇨침사Decoy세포양성솔、BK병독뇨증、BK병독혈증급BK병독DNA양성솔균고우비BKVAN조(P＜0.05).뇨Decoy세포예측BKVAN적음성예측치위0.949,민감도위0.995,균최고;BK병독혈증예측BKVAN적양성예측치위0.770,특이성위0.977,균최고.삼항사사지표예측BKVAN B기적민감성、특이성、양성예측치、음성예측치최고.결론 뇨침사세포학결합BK병독DNA적혈、뇨검측,병주의관찰신이식수자상규수방검사적세절,가이급시발현이식신BKVAN.
Objective To investigate the clinical diagnoses of BK virus-associated nephropathy (BKVAN) and estimate the utility of screening methods for BKVAN in different patterns.Method We used three screening methods for BKVAN including quantitative PCR assay for BKV DNA load in urine and plasma,and quantitative assay of urine cytology concurrently with renal transplant biopsies for the evaluation of 479 patients.The renal allograft biopsy specimens were analyzed by routine histologic examination,immunohistochemistry,and classified into three categories of BKVAN.These three screening methods were compared for prediction of different patterns of BKVAN.Results BKVAN was diagnosed in 39 (8.1％) of 479 renal recipients.There were 9,25 and 5 cases of BKVAN at stage A,B and C,respectively.FK506 + MMF immunosuppressive agents were used in these 39 BKVAN recipients.The average level of serum creatinine and the specific gravity of urine were 194.9 μmol/L and 1.007 respectively.No proteinuria occurred in 34 BKVAN recipients.The incidence and the median level of the number of the decoy cells,and BK viral load in urine and plasma were higher in the BKVAN group than those in non-BKVAN group (P＜0.05 for all).Decoy cells had a high negative predictive value of 94.9％ and a high sensitivity of 99.5％ for BKVAN.BK viremia had a high positive predictive value of 77.0％ and a high specificity of 97.7％ for BKVAN.Combined use of these three screening methods had a high sensitivity,specificity,negative predictive value and positive predictive value for BKVAN pattern B.Conclusion Urine cytology and BKV DNA detection in the urine and peripheral blood combined with the careful observation of the routine tests are very useful and sensitive for the evaluation of BKVAN in renal transplant recipients.