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目的探讨影响BK病毒(BKV)相关性肾病(BKVAN)的肾移植受者病毒清除的因素,分析病毒清除过程对移植肾功能及长期预后的影响。方法入选通过移植肾穿刺活检并结合尿沉渣Decoy细胞计数,尿、血标本中BK病毒DNA含量的测定,确诊的BKVAN 49例,进行减少免疫抑制剂强度的治疗,并定期监测BKV的活动及移植肾功能。根据BKV(包括Decoy细胞、BKV尿症和BKV血症)有无清除,将BKVAN受者分成清除组与未清除组,比较两组间和组内确诊时、调药后6和12个月血清肌酐的差异及两组间各项临床指标的差异。应用Kaplan-Meier方法计算BKV清除所需时间及移植肾1、3、5年存活率,应用Log-Rank检验比较BKV清除组与未清除组移植肾存活率的差异。结果 BKVAN受者在降低免疫抑制强度后Decoy细胞、BKV尿症、BKV血症清除率为63.8%、27.7%和80.5%。Kaplan-Meier方法计算Decoy细胞、BKV尿症和BKV血症清除所需中位时间分别为11、41和5个月。是否术后规律监测BKV影响病毒的清除(P<0.05)。BKV清除组调药后6和12个月的血清肌酐较确诊时有所下降或无明显差异,而未清除组相应的肌酐水平有所上升。两组间比较6和12个月与确诊时血清肌酐差值,BKV清除组低于未清除组(P<0.05)。调药后所有BKVAN受者均无急性排斥反应的发生。BKVAN受者移植肾1、3和5年存活率分别100%、83.4%和66.4%。BKV清除组的移植肾1、3和5年存活率明显高于相应的未清除组(P<0.05)。结论术后规律监测BKV、早期移植肾活检发现BKVAN有利于BKV的清除,而病毒能否被清除影响移植肾功能及长期存活率。
Objective To investigate the factors influencing the clearance of virus in renal transplant recipients of BKV-related nephropathy (BKVAN) and to analyze the effect of virus clearance on the function and long-term prognosis of renal allograft. Methods Forty-nine patients with BKVAN diagnosed by transplanted renal biopsy combined with Decoy cell count, urinary and blood samples of urinary sediment were treated with BKVAN to reduce the intensity of immunosuppressive agents and to monitor the activity and transplantation of BKV Kidney function. According to the presence or absence of BKV (including Decoy cells, BKVuria and BKV hyperlipidemia), BKVAN recipients were divided into clear group and non-clear group. Creatinine differences and differences between the two groups of clinical indicators. Kaplan-Meier method was used to calculate the time required for BKV clearance and the 1, 3, 5-year survival rate of renal allograft. Log-Rank test was used to compare the survival rate of BKV-treated and non-cleared groups. Results In BKVAN recipients, Decoy cells, BKVuria and BKV seroprevalence were 63.8%, 27.7% and 80.5% after decreasing the intensity of immunosuppression. The median time required for the Decoy cells, BKVuria, and BKV clearance to be calculated by the Kaplan-Meier method was 11, 41, and 5 months, respectively. Whether postoperative regular monitoring of BKV affected the clearance of the virus (P <0.05). Serum creatinine at 6 and 12 months after drug administration in BKV clearance group decreased or did not differ significantly from that at diagnosis, whereas the corresponding creatinine level did not increase in the BKV clearance group. The differences of serum creatinine between the two groups at 6 and 12 months and those at the time of diagnosis were lower than those in the group without BKV clearance (P <0.05). None of the BKVAN recipients experienced any acute rejection after drug administration. The 1-, 3-, and 5-year survival rates of BKVAN recipients were 100%, 83.4% and 66.4%, respectively. The 1, 3, and 5-year survival rates of the grafted kidneys in the BKV-treated group were significantly higher than those in the untreated group (P <0.05). Conclusions The postoperative regular monitoring of BKV and early renal transplantation biopsy found that BKVAN is helpful for the clearance of BKV, and whether the virus can be cleared affects the renal function and long-term survival.