中华医学杂志
中華醫學雜誌
중화의학잡지
National Medical Journal of China
2015年
38期
3124-3127
,共4页
黄刚%王长希%罗小菁%黄燕纯%费继光%邓素雄%李军%陈国栋%付茜
黃剛%王長希%囉小菁%黃燕純%費繼光%鄧素雄%李軍%陳國棟%付茜
황강%왕장희%라소정%황연순%비계광%산소웅%리군%진국동%부천
肾移植%BK病毒%BK病毒相关性肾病%危险因素
腎移植%BK病毒%BK病毒相關性腎病%危險因素
신이식%BK병독%BK병독상관성신병%위험인소
Kidney transplantation%BK virus%BK virus-associated nephropathy%Risk factors
目的 探讨影响肾移植受者BK病毒相关性肾病(BKVAN)的危险因素.方法 选取2006年1月至2014年12月于中山大学附属第一医院行移植肾穿刺活检的615例肾移植受者,肾穿刺同时收集血、尿标本,进行尿沉渣Decoy细胞计数,尿、血标本中BK病毒(BKV)DNA含量的检测.并且运用普通病理染色、免疫组织化学染色的方法检查移植肾组织确定BKVAN的诊断并进行病理分期.应用Logistic回归法分析筛选BKVAN的危险因素.结果 615例肾移植受者尿液Decoy细胞、尿BKV DNA及血BKV DNA的阳性率分别为13.7％(84/615)、29.3％(180/615)和8.8％(54/615).病理确诊BKVAN49例.BKVAN患者尿沉渣Decoy细胞阳性率、尿、血标本中BK病毒DNA阳性率及含量均高于无BKVAN患者(P＜0.05).他克莫司(Tac)联合霉酚酸(MPA)维持治疗方案(OR=12.4,P=0.001)和移植后重症肺炎(OR =3.7,P=0.001)是影响肾移植受者BKVAN发生的独立危险因素.结论 使用Tac+ MPA的用药组合,并且检测到BKV复制明显的肾移植受者,诊断上应高度警惕BKVAN.
目的 探討影響腎移植受者BK病毒相關性腎病(BKVAN)的危險因素.方法 選取2006年1月至2014年12月于中山大學附屬第一醫院行移植腎穿刺活檢的615例腎移植受者,腎穿刺同時收集血、尿標本,進行尿沉渣Decoy細胞計數,尿、血標本中BK病毒(BKV)DNA含量的檢測.併且運用普通病理染色、免疫組織化學染色的方法檢查移植腎組織確定BKVAN的診斷併進行病理分期.應用Logistic迴歸法分析篩選BKVAN的危險因素.結果 615例腎移植受者尿液Decoy細胞、尿BKV DNA及血BKV DNA的暘性率分彆為13.7％(84/615)、29.3％(180/615)和8.8％(54/615).病理確診BKVAN49例.BKVAN患者尿沉渣Decoy細胞暘性率、尿、血標本中BK病毒DNA暘性率及含量均高于無BKVAN患者(P＜0.05).他剋莫司(Tac)聯閤黴酚痠(MPA)維持治療方案(OR=12.4,P=0.001)和移植後重癥肺炎(OR =3.7,P=0.001)是影響腎移植受者BKVAN髮生的獨立危險因素.結論 使用Tac+ MPA的用藥組閤,併且檢測到BKV複製明顯的腎移植受者,診斷上應高度警惕BKVAN.
목적 탐토영향신이식수자BK병독상관성신병(BKVAN)적위험인소.방법 선취2006년1월지2014년12월우중산대학부속제일의원행이식신천자활검적615례신이식수자,신천자동시수집혈、뇨표본,진행뇨침사Decoy세포계수,뇨、혈표본중BK병독(BKV)DNA함량적검측.병차운용보통병리염색、면역조직화학염색적방법검사이식신조직학정BKVAN적진단병진행병리분기.응용Logistic회귀법분석사선BKVAN적위험인소.결과 615례신이식수자뇨액Decoy세포、뇨BKV DNA급혈BKV DNA적양성솔분별위13.7％(84/615)、29.3％(180/615)화8.8％(54/615).병리학진BKVAN49례.BKVAN환자뇨침사Decoy세포양성솔、뇨、혈표본중BK병독DNA양성솔급함량균고우무BKVAN환자(P＜0.05).타극막사(Tac)연합매분산(MPA)유지치료방안(OR=12.4,P=0.001)화이식후중증폐염(OR =3.7,P=0.001)시영향신이식수자BKVAN발생적독립위험인소.결론 사용Tac+ MPA적용약조합,병차검측도BKV복제명현적신이식수자,진단상응고도경척BKVAN.
Objective To analyze the risk factors affecting BK virus associated nephropathy (BKVAN) after kidney transplantation.Methods Three screening methods for BKVAN including quantitative PCR assay for BK virus(BKV) DNA load in urine and plasma and quantitative assay of urine cytology concurrently with renal transplant biopsies for the evaluation of 615 patients from January 2006 to December 2014 were used.The renal allograft biopsy specimens were analyzed by routine histologic examination,immunohistochemistry and classified into three categories of BKVAN.Potential variables were analyzed by Logistic regression model multivariate analysis to assess and rank BKVAN related risk factors.Results The positive rate of urine decoy cell,BKV viruria and viremia in 615 renal recipients were 13.7％ (84/615),29.3％ (180/615),and 8.8％ (54/615),respectively.BKVAN were diagnosed in 49 recipients.The incidence and the median level of the number of the decoy cell,BK viral load in urine and plasma were higher in the BKVAN group than those in non-BKVAN group (all P ＜ 0.05).Tacrolimus (Tac) combined with mycopbenolic acid (MPA) protocol (OR =12.4,P =0.001) and severe pneumonia post-transplant (OR =3.7,P =0.001) were the independent risk factors impacting on BKVAN in renal recipients.Conclusions The renal recipients with high level of BKV replication,whose immunosuppressant protocol include Tac and MPA,should be suspected the diagnosis of BKVAN.
