Clinical diagnosis and treatment specifcation for BK virus infection and BK virus nephropathy in organ transplant recipients in China (2019 edition)
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摘要: 为了进一步规范中国实体器官移植受者BK病毒(BKV)感染和BKV性肾病(BKVN)的诊断和治疗,中华医学会器官移植学分会组织器官移植专家和感染病学专家,在《中国实体器官移植受者BK病毒感染临床诊疗指南(2016版)》的基础上,从概述和流行病学特点、临床表现、诊断、预防、治疗、随访、预后等方面,制订本规范,以帮助器官移植工作者规范和优化BKV感染及相关疾病的诊断和治疗。
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表 1 BKVN发生的危险因素
Table 1. Risk factors of BKVN
分类 危险因素 供者因素 HLA错配 尸体供肾 女性 受者因素 高龄 男性 移植后其他因素 手术损伤、冷缺血时间 输尿管支架、输尿管狭窄 急性排斥反应和抗排斥反应治疗 大量糖皮质激素暴露 抗淋巴细胞抗体 强效免疫抑制方案他克莫司联合吗替麦考酚酯 因BKVN致移植物失功后再次移植 HLA为人类白细胞抗原 表 2 BKVN分型及预后情况
Table 2. Classification and prognosis of BKVN
BKVN分型 病理学表现 病变程度 病变范围 移植物功能 移植器官功能衰竭风险 A型 病毒导致的细胞病理学改变 轻微 ≤25% 大多在基线 < 10% 间质炎症 较轻 ≤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% 大多有受损 50% 间质炎症 明显 11%~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% B3型 间质炎症 广泛 > 50% 明显受损 50% C型 病毒导致的细胞病理学改变 多样 多样 明显受损,进展至功能衰竭 > 80% 间质炎症 多样 多样 肾小管萎缩 广泛 > 50% 间质纤维化 广泛 > 50% -
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