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摘要:
目的 分析肾移植术后高水平BK病毒尿症的危险因素及其对预防BK病毒相关性肾病(BKVAN)的意义。 方法 回顾性分析262例保留规律随访资料的肾移植受者的临床资料。根据受者BK病毒DNA载量分为高水平BK病毒尿症组(35例)和非高水平BK病毒尿症组(227例)。总结肾移植术后高水平BK病毒尿症的发生情况;采用单因素和多因素分析肾移植术后发生高水平BK病毒尿症的危险因素;采用Kaplan-Meier法绘制生存曲线,对受者进行生存分析。 结果 262例肾移植受者中,35例发生高水平BK病毒尿症,发生率为13.4%。发生中位时间181(126,315)d,发生率在移植术后6个月内最高,6个月至2年逐渐降低,2年后有所回升。单因素分析结果提示抗胸腺细胞球蛋白(ATG)治疗史、急性排斥反应(AR)、捐献类型及移植物功能延迟恢复(DGF)是肾移植术后发生高水平BK病毒尿症的危险因素(均为P < 0.05)。多因素Cox回归分析结果显示脑-心双死亡器官捐献(DBCD)、AR及DGF是肾移植术后发生高水平BK病毒尿症的独立危险因素。有ATG治疗史、发生AR、发生DGF以及捐献类型为DBCD的受者的1、3、5年生存率分别低于无ATG治疗史、无发生AR、无发生DGF及其他捐献类型[脑死亡器官捐献(DBD)、心脏死亡器官捐献(DCD)和活体器官捐献]的受者(均为P < 0.05)。 结论 DBCD、AR及DGF是肾移植术后发生高水平BK病毒尿症的独立危险因素,加强对此类受者的术后监测并给予早期干预可能是预防BKVAN的有效方式。 -
关键词:
- 肾移植 /
- BK病毒 /
- BK病毒尿症 /
- BK病毒血症 /
- BK病毒相关性肾病(BKVAN) /
- 急性排斥反应(AR) /
- 移植物功能延迟恢复(DGF) /
- 脑-心双死亡器官捐献(DBCD)
Abstract:Objective To analyze the risk factors of high-level BK viruria after renal transplantation and the significance in preventing BK virus-associated nephropathy (BKVAN). Methods Clinical data of 262 renal transplant recipients with regular follow-up data were retrospectively analyzed. According to the DNA load of BK virus, all recipients were divided into the high-level BK viruria group (n=35) and non-high-level BK viruria group (n=227). The incidence of high-level BK viruria after renal transplantation was summarized. The risk factors of high-level BK viruria after renal transplantation were analyzed by univariate analysis and multivariate analysis. Survival curve was delineated by Kaplan-Meier method, and survival analysis of recipients was performed. Results Among 262 renal transplant recipients, 35 cases developed high-level BK viruria with an incidence of 13.4%. The median time of occurrence of high-level BK viruria was 181 (126, 315) d. The incidence was the highest within 6 months after renal transplantation, gradually decreased from 6 months to 2 years, and then increased after 2 years. Univariate analysis showed that the history of antithymocyte globulin (ATG) treatment, acute rejection (AR), donation type and delayed graft function (DGF) were the risk factors of high-level BK viruria after renal transplantation (all P < 0.05). Multivariate Cox regression analysis demonstrated that donation after brain death followed by cardiac death (DBCD), AR and DGF were the independent risk factors of high-level BK viruria after renal transplantation. The 1-, 3- and 5-year survival rates of recipients with ATG treatment history, AR, DGF and donation type of DBCD were significantly lower than those with non-ATG treatment history, non-AR, non-DGF and other donation types [donation after brain death (DBD), donation after cardiac death (DCD) and living organ donation] respectively (all P < 0.05). Conclusions DBCD, AR and DGF are the independent risk factors of high-level BK viruria after renal transplantation. Strengthening the postoperative monitoring of these recipients and delivering early intervention may effectively prevent BKVAN. -
表 1 肾移植术后发生高水平BK病毒尿症危险因素的单因素分析
Table 1. Univariate analysis of the risk factors for high level BK viruria after renal transplantation
变量 高水平BK病毒尿症组
(n=35)非高水平BK病毒尿症组
(n=227)统计值 P值 供者因素
性别[n(%)]
男
女
28(80)
7(20)
169(74)
58(26)
0.543
0.461
年龄[n(%)]
< 18岁
18~59岁
≥60岁
3(9)
32(91)
0
24(11)
200(88)
3(1)0.589
0.745
BMI[n(%)]
< 18.0 kg/m2
18.0~23.9 kg/m2
24.0~27.9 kg/m2
≥28.0 kg/m2
3(9)
24(69)
7(20)
1(3)
24(11)
137(60)
57(25)
9(4)0.886
0.829
捐献类型[n(%)]
活体器官捐献DBD①
DCD②
DBCD③
4(11)
1(3)
9(26)
21(60)
36(16)
11(5)
129(57)
51(22)26.160
< 0.001
获取前Scr[M(Q25, Q75),μmol/L] 77(53,136) 77(60,116) -0.328 0.743 供肾位置
左肾
右肾
19(54)
16(46)
122(54)
105(46)0.001
0.980
受者因素
性别[n(%)]
男
女
22(63)
13(37)
167(74)
60(26)
1.593
0.207
年龄[n(%)]
< 18岁
18~59岁
≥60岁
0
34(97)
1(3)
2(1)
220(97)
5(2)0.390
0.823
BMI[n(%)]
< 18.0 kg/m2
18.0~23.9 kg/m2
24.0~27.9 kg/m2
≥28.0 kg/m2
3(9)
28(80)
3(9)
1(3)
33(15)
159(70)
33(15)
2(1)3.282
0.350
术前透析方式[n(%)]
血液透析
腹膜透析
其它
25(71)
10(29)
0
184(81)
41(18)
2(1)2.572
0.276
ATG治疗史[n(%)]
有
否
17(49)
18(51)
69(30)
158(70)4.374
0.036
AR[n(%)]
有
否
12(34)
23(66)
33(15)
194(85)8.819
0.003
DGF[n(%)]
有
否
16(46)
19(54)
31(14)
196(86)23.073
< 0.001
术后30 d内感染史[n(%)]
肺部感染
泌尿系统感染
其它
3(9)
4(11)
28(80)
11(5)
10(4)
205(90)4.024
0.134
免疫因素
免疫抑制维持方案[n(%)]
Tac+MMF+Pred④
其它
34(97)
1(3)
225(99)
2(1)
0.628
0.428
移植次数[n(%)]
首次
二次
35(100)
0
223(98)
4(2)0.565
0.754
HLA错配点数(x±s, 个) 1.9±1.2 2.0±1.0 6.805 0.236 冷缺血时间(x±s, h) 10±4 10±5 0.555 0.576 热缺血时间(x±s, min) 4.8±1.2 4.5±1.3 -1.466 0.149 注:① DBD为脑死亡器官捐献。
② DCD为心脏死亡器官捐献。
③ DBCD为脑- 心双死亡器官捐献。
④ Tac+MMF+Pred为他克莫司+ 吗替麦考酚酯+ 泼尼松。 -
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