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肾移植术后高水平BK病毒尿症危险因素分析

熊睿 丁利民 杨华 李新长

熊睿, 丁利民, 杨华, 等. 肾移植术后高水平BK病毒尿症危险因素分析[J]. 器官移植, 2021, 12(3): 317-323. doi: 10.3969/j.issn.1674-7445.2021.03.010
引用本文: 熊睿, 丁利民, 杨华, 等. 肾移植术后高水平BK病毒尿症危险因素分析[J]. 器官移植, 2021, 12(3): 317-323. doi: 10.3969/j.issn.1674-7445.2021.03.010
Xiong Rui, Ding Limin, Yang Hua, et al. Analysis of risk factors of high-level BK viruria after renal transplantation[J]. ORGAN TRANSPLANTATION, 2021, 12(3): 317-323. doi: 10.3969/j.issn.1674-7445.2021.03.010
Citation: Xiong Rui, Ding Limin, Yang Hua, et al. Analysis of risk factors of high-level BK viruria after renal transplantation[J]. ORGAN TRANSPLANTATION, 2021, 12(3): 317-323. doi: 10.3969/j.issn.1674-7445.2021.03.010

肾移植术后高水平BK病毒尿症危险因素分析

doi: 10.3969/j.issn.1674-7445.2021.03.010
基金项目: 

江西省科技厅重点研发项目基金 20151BBG70069

详细信息
    作者简介:

    熊睿,男,1996年生,硕士,住院医师,研究方向为肾移植术后病毒感染,Email:xiongrui55@hotmail.com

    通讯作者:

    李新长,男,1966年生,主任医师,研究方向为肾移植临床与基础,Email:lixinchang001@hotmail.com

  • 中图分类号: R617, R692

Analysis of risk factors of high-level BK viruria after renal transplantation

More Information
  • 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。

     

  • 图  1  肾移植受者的生存曲线

    注:A图为有否ATG治疗史的肾移植受者的生存曲线;B图为有否发生AR的肾移植受者的生存曲线;C图为有否发生DGF的肾移植受者的生存曲线;D图为不同捐献类型的肾移植受者的生存曲线。

    Figure  1.  Survival curves of renal transplant recipients

    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
    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DBD
        DCD
        DBCD
     
    4(11)
    1(3)
    9(26)
    21(60)
     
    36(16)
    11(5)
    129(57)
    51(22)
    26.160
     
     
     
     
    < 0.001
     
     
     
     
      获取前Scr[MQ25, 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+Pred
        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。
    下载: 导出CSV
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出版历程
  • 收稿日期:  2021-01-23
  • 网络出版日期:  2021-05-19
  • 刊出日期:  2021-05-15

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