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目的探讨肾移植术后多瘤病毒(BKV)感染的诊断方法、监测指标及初步治疗方法。方法采集64例肾移植受者的血、尿样本,行BKV细胞学与聚合酶链反应(PCR)检测。对肾移植术后BKV感染的流行病学以及相关因素进行分析,并对BKV感染的受者进行试验性治疗。结果64例受者的尿Decoy细胞、多瘤病毒尿症与多瘤病毒血症的阳性率分别为28.7%、17.2%和6.3%。血肌酐(Cr)升高的受者尿Decoy细胞阳性率高于血Cr稳定的受者(P=0.04)。受者的性别、年龄、诱导治疗方案、是否发生急性排斥反应以及术后肾功能恢复情况等临床因素与尿Decoy细胞、多瘤病毒尿症及多瘤病毒血症的出现无明显相关性。应用更昔洛韦试验性治疗4例BKV感染的受者,治疗2~3周后,受者的尿Decoy细胞以及血、尿BKV DNA均转为阴性。结论血肌酐水平升高的肾移植受者易发生BKV再活化。可通过检测血BKV DNA筛查BKV相关的移植肾肾病。更昔洛韦治疗BKV具有良好的疗效,但需进一步验证。
Objective To investigate the diagnosis, detection and initial treatment of polyomavirus (BKV) infection after renal transplantation. Methods Totally 64 blood and urine samples from kidney transplant recipients were collected and tested by BKV cytology and polymerase chain reaction (PCR). The epidemiology and related factors of BKV infection after renal transplantation were analyzed, and the experimental treatment of BKV infected recipients was conducted. Results The positive rates of urinary Decoy cells, polyomavirus and polyomaviruses in 64 patients were 28.7%, 17.2% and 6.3%, respectively. The positive rate of Decoy cells in patients with elevated serum creatinine (Cr) was higher than those in patients with stable blood Cr (P = 0.04). There was no significant correlation between the clinical factors such as gender, age, induction therapy, acute rejection and postoperative recovery of renal function, and the appearance of Decoy cells, polyomavirus and polyoma viremia. Four patients with BKV infection were treated experimentally with ganciclovir. After 2 to 3 weeks of treatment, the recipient’s urine Decoy cells and blood and urine BKV DNA turned negative. Conclusion In renal transplant recipients with elevated serum creatinine level, BKV reactivation is prone to occur. BKV-associated transplant kidney disease can be screened for blood BKV DNA testing. Ganciclovir treatment of BKV has a good effect, but further verification.