摘要
目的探讨肾移植受者术后BK病毒(BKV)复制的干预时机及转归。方法回顾性分析2012年4月~2015年4月在我院检测尿液BKV载量≥1.0×10~4/m L肾移植受者的临床资料,选择47例同期接受移植且尿液或血液BKV载量<1.0×10~4/m L肾移植受者作为对照。结果最终入组实验组54例:A组(尿BKV载量1.0×10~4~1.0×10~7/m L)22例,B组(尿BKV载量>1.0×10~7/m L)24例,C组(血BKV载量≥1.0×10~4/m L)8例;对照组47例。经3.2~34.5个月的随访,实验组在干预后尿液、血浆BKV载量均明显降低(P值均<0.05)。进一步比较干预前后估算肾小球滤过率(eGFR)水平,A组:18例(81.82%)eGFR稳定或好转,4例(18.18%)eGFR降低;B组:19例(79.17%)eGFR稳定或好转,5例(20.83%)eGFR降低;C组:4例(50%)eGFR稳定,4例(50%)eGFR降低。截止至末次随访,A组、B组的平均eGFR与对照组比较均无统计学差异(P值均≥0.05),C组的平均eGFR较对照组明显降低(P=0.001)。依各组移植肾eGFR变化趋势显示:干预后A组以及对照组随访期间移植效果最好,eGFR稳定,略呈上升状态。结论在BKV复制早期(尿液BKV≥1.0×10~4/m L)就予以干预,进行适度的免疫抑制剂减量,有利于稳定移植肾功能,改善移植肾长期存活。
Objective To investigate the optimal time window for intervention of BK virus （BKV） replication and its effect on the outcomes of kidney transplant recipients （KTRs）. Methods A retrospective analysis of the clinical data and treatment regimens was conducted among KTRs whose urine BKV load was≥1.0×104 copies/mL following the operation between April, 2000 and April, 2015. KTRs with urine BKV load 〈1.0 × 104 copies/mL matched for transplantation time served as the control group. Results A total of 54 recipients positive for urine BKV were included in the analysis. According to urine BKV load, the recipients were divided into 3 groups：group A with urine BKV load of 1.0 ×104-1.0 × 107 copies/mL （n=22）, group B with urine BKV load〉1.0×107 copies/mL （n=24）, and group C with plasma BKV load≥1.0×104 copies/mL （n=8）;47 recipients were included in the control group. During the follow-up for 3.2-34.5 months, the urine and plasma BKV load was obviously lowered after intervention in all the 54 BKV-positive recipients （P〈0.05）. Eighteen （81.82%） of the recipients in group A and 19 （79.17%） in group B showed stable or improved estimated glomerular filtration rate （eGFR） after the intervention;in group C, 4 recipients （50%） showed stable eGFR after the intervention. In the last follow-up, the recipients in groups A and B showed similar eGFR with the control group （P〉0.05）, but in group C, eGFR was significantly lower than that of the control group （P=0.001）. The recipients in group A and the control group had the best allograft outcome with stable or improved eGFR. Conclusion Early intervention of BKV replication （urine BKV load ≥1.0× 104 copies/mL） in KTRs with appropriate immunosuppression reduction can be helpful for stabilizing the allograft function and improving the long-term outcomes.
出处
《南方医科大学学报》
CAS
CSCD
北大核心
2017年第8期1110-1115,共6页
Journal of Southern Medical University
基金
国家自然科学基金(81500573)
南方医科大学南方医院院长基金项目(2013B011)
南方医科大学南方医院院级教育课题(14NJ-ZL01)
南方医科大学大学生创新创业训练项目基金(201612121006)~~
关键词
肾移植
BK病毒复制
干预时机
免疫抑制剂减量
kidney transplant
BK virus replication
intervention time
immunosuppression reduction
