中远期肾移植受者BK病毒感染的临床研究
发布时间：2018-09-01 05:56
【摘要】：目的： 探讨中远期肾移植受者(术后1年以上)BK病毒感染及其对移植肾功能影响，分析BK病毒感染危险因素。 方法： 选取2013年5月至10月在解放军第309医院随诊的167例中远期肾移植受者为研究对象，规律随访6个月，每2个月分别留取受者尿液及血液标本，并记录受者性别、年龄、体重指数(BMI)、术后时间、免疫抑制方案、供肾类型、手术前后有无糖尿病、是否发生过移植肾功能延迟恢复(DGF)、是否接受过激素冲击治疗、近期有无其他感染和肾功能情况。应用BKV DNA定量检测试剂盒和荧光实时定量PCR技术检测受者尿液和血液中BKV DNA载量，依据载量结果将研究对象分成四组：病毒血症组、持续性病毒尿症组、一过性病毒尿症组、阴性对照组。应用SPSS16.0进行统计分析，计量资料采用t检验、F检验或秩和检验，计数资料采用卡方检验或秩和检验，比较各组间肾功能情况有无差异，应用logistic回归法分析远期肾移植受者BK病毒感染危险因素。 结果： (1)167例受者中病毒血症组、持续性病毒尿症组、一过性病毒尿症组的发生率分别为3.6%(6/167)、6.6%(11/167)、8.9%(15/167)。持续性病毒尿症阳性率随着术后时间推移而逐渐降低(1～3年：12.8%；3～5年：4.0%；5～10年：3.1%；≥10年：0%)。持续性病毒尿症病毒载量明显高于病毒血症(2.0×109vs2.8×106copies/ml，P=0.003)及一过性病毒尿症(2.0×109vs2.6×106copies/ml，P=0.001)。 (2)病毒血症随访开始时血肌酐值明显高于持续性病毒尿症(203.5±38.6umol/L vs125.8±41.7umol/L，P=0.007)、一过性病毒尿症(203.5±38.6umol/L vs92.7±26.4umol/L，P=0.000)及阴性对照组(203.5±38.6umol/L vs111.3±59.2umol/L，P=0.000)。病毒血症血肌酐变化值(随访开始时血肌酐值减去出院时血肌酐值)亦明显高于持续性病毒尿症(87.5±25.1umol/L vs40.4±38.1umol/L，P=0.002)、一过性病毒尿症(87.5±25.1umol/L vs8.3±11.9umol/L，P=0.000)及阴性对照组(87.5±25.1umol/L vs14.0±24.7umol/L，P=0.000)。此外，持续性病毒尿症的血肌酐变化值明显高于一过性病毒尿症(40.4±38.1umol/L vs8.3±11.9umol/L， P=0.015)及阴性对照组(40.4±38.1umol/L vs14.0±24.7umol/L，P=0.012)。 (3)单因素相关分析示受者年龄、性别、体重指数、供肾类型、手术前后有无糖尿病、是否使用ATG免疫诱导、是否接受过激素冲击治疗、有无DGF、近期有无其他感染与BK病毒感染无相关性；移植术后时间与BK病毒感染呈负相关(r=-0.174，P=0.025)；相比于CsA，服用FK506为主的免疫抑制方案与BK病毒感染呈正相关(r=0.179,P=0.024)。进一步以CNI类药物浓度为指标分层，分层分析示FK506浓度(以谷浓度6ng/ml为界)与BK病毒感染无相关性，而CsA浓度(以谷浓度150ng/ml为界)与BK病毒感染呈负相关。以免疫抑制药物组合方案为指标分层，分层分析示FK506+MZR+Pred或CsA+MMF+Pred与BK病毒感染无相关性，而FK506+MMF+Pred三联免疫抑制方案仍与BK病毒感染呈正相关(r=0.186，P=0.030)，CsA+MZR+Pred方案与BK病毒呈负相关(r=-0.177，P=0.016)。多因素分析示移植术后1～2年内受者CNI类免疫抑制药物谷浓度高(FK5066ng/ml或CsA150ng/ml)是BK病毒感染危险因素(OR=9.375，95%CI=1.035～84.90，，P=0.047)。 结论： 移植术后1～3年内，中远期肾移植受者BK病毒血症或持续性BKV尿症阳性率高；病毒血症及持续性病毒尿症是导致移植肾功能减退的重要原因；移植术后1～2年内受者药物谷浓度高(FK5066ng/ml或CsA150ng/ml)是BK病毒发病危险因素。
[Abstract]:Objective:
Objective To investigate the BK virus infection and its influence on renal function in long-term renal transplant recipients (more than one year after operation) and analyze the risk factors of BK virus infection.
Method:
A total of 167 middle-and long-term renal transplant recipients were selected from May to October 2013 in the 309th Hospital of the PLA. They were followed up regularly for 6 months. Their urine and blood samples were taken every 2 months. Their gender, age, body mass index (BMI), postoperative time, immunosuppressive regimen, donor type, diabetes mellitus before and after operation were recorded. Whether delayed graft function (DGF) has occurred, whether hormone shock therapy has been given, whether there have been other infections and kidney function in the near future. SPSS16.0 was used for statistical analysis. T test, F test or rank sum test were used for quantitative data. Chi-square test or rank sum test were used for quantitative data. Differences in renal function between groups were compared. Logistic regression was used to analyze BK virus infection in long-term renal transplant recipients. Risk factors.
Result:
(1) The incidence of viremia, persistent viruria, transient viruria were 3.6% (6/167), 6.6% (11/167) and 8.9% (15/167), respectively. The positive rate of persistent viruria gradually decreased with the time after surgery (1-3 years: 12.8%; 3-5 years: 4.0%; 5-10 years: 3.1%; 10 years: 0%). Urinary viral load was significantly higher than that of viremia (2.0 x 109 vs 2.8 x 106 copies / ml, P = 0.003) and transient viral urine (2.0 x 109 vs 2.6 x 106 copies / ml, P = 0.001).
(2) The serum creatinine level at the beginning of follow-up was significantly higher in viremia than that in persistent viruria (203.5 6550 The serum creatinine level at the time of discharge was significantly higher than that at the time of discharge in persistent viral urine (87.5 6550 The value of metaplasia was significantly higher than that of transient viruria (40.4
(3) Univariate correlation analysis showed that age, sex, body mass index, type of donor kidney, pre-and post-operative diabetes mellitus, ATG immune induction, hormone shock therapy, DGF and other recent infections were not correlated with BK virus infection, and the time after transplantation was negatively correlated with BK virus infection (r = - 0.174, P = 0.025). Compared with CsA, FK506-based immunosuppressive regimen was positively correlated with BK virus infection (r = 0.179, P = 0.024). Further stratification with CNI concentration as an indicator showed that FK506 concentration (with a threshold of 6ng/ml) was not correlated with BK virus infection, while CsA concentration (with a threshold of 150ng/ml) was negatively correlated with BK virus infection. Hierarchical analysis showed that FK506 + MZR + Pred or CsA + MMF + Pred had no correlation with BK virus infection, while FK506 + MMF + Pred triple immunosuppressive regimen was still positively correlated with BK virus infection (r = 0.186, P = 0.030), and CsA + MZR + Pred regimen was negatively correlated with BK virus infection (r = - 0.177, P = 0.016). The high valley concentration of CNI immunosuppressants (FK5066ng/ml or CsA150ng/ml) in recipients within 1 to 2 years was a risk factor for BK virus infection (OR = 9.375, 95% CI = 1.035-84.90, P = 0.047).
Conclusion:
The positive rate of BK viremia or persistent BKV urine was high in mid-and long-term renal transplant recipients within 1-3 years after transplantation, viremia and persistent viruria were the main causes of renal allograft dysfunction, and the high drug trough concentration (FK5066ng/ml or CsA150ng/ml) in recipients within 1-2 years after transplantation was the risk factor for BK virus.
【学位授予单位】：中国人民解放军医学院
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R699.2
本文编号：2216319
[Abstract]:Objective:
Objective To investigate the BK virus infection and its influence on renal function in long-term renal transplant recipients (more than one year after operation) and analyze the risk factors of BK virus infection.
Method:
A total of 167 middle-and long-term renal transplant recipients were selected from May to October 2013 in the 309th Hospital of the PLA. They were followed up regularly for 6 months. Their urine and blood samples were taken every 2 months. Their gender, age, body mass index (BMI), postoperative time, immunosuppressive regimen, donor type, diabetes mellitus before and after operation were recorded. Whether delayed graft function (DGF) has occurred, whether hormone shock therapy has been given, whether there have been other infections and kidney function in the near future. SPSS16.0 was used for statistical analysis. T test, F test or rank sum test were used for quantitative data. Chi-square test or rank sum test were used for quantitative data. Differences in renal function between groups were compared. Logistic regression was used to analyze BK virus infection in long-term renal transplant recipients. Risk factors.
Result:
(1) The incidence of viremia, persistent viruria, transient viruria were 3.6% (6/167), 6.6% (11/167) and 8.9% (15/167), respectively. The positive rate of persistent viruria gradually decreased with the time after surgery (1-3 years: 12.8%; 3-5 years: 4.0%; 5-10 years: 3.1%; 10 years: 0%). Urinary viral load was significantly higher than that of viremia (2.0 x 109 vs 2.8 x 106 copies / ml, P = 0.003) and transient viral urine (2.0 x 109 vs 2.6 x 106 copies / ml, P = 0.001).
(2) The serum creatinine level at the beginning of follow-up was significantly higher in viremia than that in persistent viruria (203.5 6550 The serum creatinine level at the time of discharge was significantly higher than that at the time of discharge in persistent viral urine (87.5 6550 The value of metaplasia was significantly higher than that of transient viruria (40.4
(3) Univariate correlation analysis showed that age, sex, body mass index, type of donor kidney, pre-and post-operative diabetes mellitus, ATG immune induction, hormone shock therapy, DGF and other recent infections were not correlated with BK virus infection, and the time after transplantation was negatively correlated with BK virus infection (r = - 0.174, P = 0.025). Compared with CsA, FK506-based immunosuppressive regimen was positively correlated with BK virus infection (r = 0.179, P = 0.024). Further stratification with CNI concentration as an indicator showed that FK506 concentration (with a threshold of 6ng/ml) was not correlated with BK virus infection, while CsA concentration (with a threshold of 150ng/ml) was negatively correlated with BK virus infection. Hierarchical analysis showed that FK506 + MZR + Pred or CsA + MMF + Pred had no correlation with BK virus infection, while FK506 + MMF + Pred triple immunosuppressive regimen was still positively correlated with BK virus infection (r = 0.186, P = 0.030), and CsA + MZR + Pred regimen was negatively correlated with BK virus infection (r = - 0.177, P = 0.016). The high valley concentration of CNI immunosuppressants (FK5066ng/ml or CsA150ng/ml) in recipients within 1 to 2 years was a risk factor for BK virus infection (OR = 9.375, 95% CI = 1.035-84.90, P = 0.047).
Conclusion:
The positive rate of BK viremia or persistent BKV urine was high in mid-and long-term renal transplant recipients within 1-3 years after transplantation, viremia and persistent viruria were the main causes of renal allograft dysfunction, and the high drug trough concentration (FK5066ng/ml or CsA150ng/ml) in recipients within 1-2 years after transplantation was the risk factor for BK virus.
【学位授予单位】：中国人民解放军医学院
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R699.2
【参考文献】
相关期刊论文 前1条
1 陆明;朱有华;王皓;韩澍;冀俊峰;;肾移植患者术后BK病毒感染的检测及危险因素分析[J];第二军医大学学报;2007年01期
本文编号：2216319
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