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摘要: BK病毒感染是肾移植术后常见且严重的并发症。由于缺少特效的抗病毒药物, 极易发展为BK病毒相关性肾病(BKVAN)。本文就BK病毒感染的普遍性, BKVAN的病程发展、诊断、治疗、预后及预防等方面进行综述。
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关键词:
- 肾移植 /
- BK病毒 /
- 活组织检查 /
- 脱氧核糖核酸拓扑异构酶
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图 1 肾移植术后BKVAN病程发展示意图
注：BK病毒尿症出现的中位时间是肾移植术后16周(2～69周)；BK病毒血症出现的中位时间是术后23周(4～73周)；当出现不明原因血清肌酐升高超过基线25%时，进行移植肾活检，病理诊断为BKVAN的中位时间是术后28周(8～86周)
Figure 1. Timeline of the development of BKVAN after renal transplantation
表 1 BKVAN的分型及预后情况
Table 1. The classification and prognosis of BKVAN
BKVAN分型 病理表现 程度 病变范围 移植器官功能 器官功能衰竭风险 A型 病毒导致的细胞病理学改变 轻微 ≤25% 间质炎症 较轻 ≤10% 大多在基线 < 10% 肾小管萎缩 较轻 ≤10% 间质纤维化 较轻 ≤10% B型 病毒导致的细胞病理学改变 多样 11%～50% 间质炎症 明显 11%～50% 大多有受损 < 50% 肾小管萎缩 中等 < 50% 间质纤维化 中等 < 50% B1型 间质炎症 中等 11%～25% 略高于基线 25% B2型 间质炎症 明显 26%～50% 明显受损 50% C型 病毒导致的细胞病理学改变 多样 多样 间质炎症 多样 多样 明显受损 > 80% 肾小管萎缩 广泛 > 50% 间质纤维化 广泛 > 50% 
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