移植患者BK病毒监测的临床意义

摘要

目的：通过对患者血或尿BK病毒（BKV）载量的监测，探讨性别、年龄、人巨细胞病毒（HCMV）及免疫抑制剂浓度等对患者BKV载量的影响，以及BKV载量对患者疾病的影响。方法用实时荧光定量聚合酶链反应（PCR）检测移植患者血浆及尿液的BKV载量。分析血浆HCMV浓度及免疫抑制剂浓度对患者BKV载量的影响以及BKV载量高低对患者肾功能的影响。结果1985例移植和非移植肾病患者中BKV阳性242例（12．1％），其中血浆阳性211例（10．6％），尿液阳性118例（5．9％）。骨髓移植患者、肾移植患者及非移植肾病患者的BKV阳性率差异有统计学意义（P＜0．01），几乎所有移植患者检测到BKV阳性都发生在移植后的前3个月中。HCMV的感染与否与患者的BKV载量差异无统计学意义（P＝0．2729）。骨髓移植及肾移植患者血浆的免疫抑制剂浓度和环孢霉素A（CsA）浓度（＞150 ng/mL）对患者BKV 载量的影响差异有统计学意义（P＜0．01）；他克莫司浓度（FK506）（＞8．0 ng/mL）与BKV载量差异无统计学意义（P＝0．2785）。BKV阳性患者与BKV阴性患者比较，肾功能中的肌酐（CREA）水平差异有统计学意义（P＝0．0207）。结论 BKV的复制与性别、年龄、是否有HCMV合并感染无关，而与血浆免疫抑制剂的浓度有关。通过对BKV载量的连续监测，调节患者免疫抑制剂的浓度，可以减少由BKV带来的二次损伤。%Objective To monitor blood and urine BK virus (BKV)load and discuss the influence of sex,age, human cytomegalovirus(HCMV)and immunosuppressor on BKV load and the influence of BKV load on diseases. Methods BKV loads of plasma and urine from patients were measured by real-time fluorescence quantitation polymerase chain reaction(PCR).The influence of plasma HCMV concentration and immunosuppressor concentrantion on BKV load and the influence of high or low BKV load on diseases were analyzed.Results BKV was detected in 242 (12.1%)cases of 1 985 patients with or without transplantation.A total of 211 cases were positive in plasma (10.6%),while 118 cases were positive in urine (5.9%).Bone marrow transplantation,kidney transplantation and none transplantation patients had different BKV positive rates with statistical significance (P<0.01).Almost all cases of BKV positive occurred in the first 3 months after transplantation.There was no statistical significance between HCMV infection and BKV load (P=0.272 9 ).Among bone marrow transplantation and kidney transplantation patients,the differences of BKV load to plasma immunosuppessor concentration and cyclosporine A (CsA ) concentration (>150 ng/mL)had statistical significance (P <0.01),those to tacrolimus (FK506)(>8.0 mg/mL)had no statistical significance (P=0.278 5 ).For BKV positive and negative patients,there was statistical significance when monitoring serum creatinine (CREA)(P=0.020 7).Conclusions There is no relationship of sex,age and concurrent infection of HCMV infection with BKV replication.However,the concentration of plasma immunosuppressor is related with BKV replication. The secondary damage can be reduced by adjusting the dose of immunosuppressor from continuously monitoring BKV load.